Provider Demographics
NPI:1083740245
Name:LAKE OZARK FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:LAKE OZARK FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-745-0049
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-8642
Practice Address - Street 1:1767 BAGNELL DAM BLVD.
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-9734
Practice Address - Country:US
Practice Address - Phone:573-365-3380
Practice Address - Fax:573-365-3758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO46568341600000X
3416L0300X
MO0290503416S0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
No3416S0300XTransportation ServicesAmbulanceWater Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO805456100Medicaid
MO149628OtherBLUE CROSS BLUE SHIELD OF
MOHEALTHLINKOtherHEALTHLINK
MO=========OtherUNITED HEALTHCARE
MO805456100Medicaid
MOHEALTHLINKOtherHEALTHLINK