Provider Demographics
NPI:1013009331
Name:MARION COUNTY AMBULANCE
Entity Type:Organization
Organization Name:MARION COUNTY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-221-5510
Mailing Address - Street 1:142 JAYCEE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-3673
Mailing Address - Country:US
Mailing Address - Phone:573-221-2117
Mailing Address - Fax:573-221-5004
Practice Address - Street 1:3120 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6571
Practice Address - Country:US
Practice Address - Phone:573-221-2117
Practice Address - Fax:573-221-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1270013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO800551301Medicaid
MO000048022OtherMEDICARE PTAN