Provider Demographics
NPI:1134127897
Name:MARIES OSAGE AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:MARIES OSAGE AMBULANCE DISTRICT
Other - Org Name:MARIES OSAGE AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LANNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-422-6123
Mailing Address - Street 1:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:MO
Mailing Address - Zip Code:65582
Mailing Address - Country:US
Mailing Address - Phone:573-422-6123
Mailing Address - Fax:573-422-6328
Practice Address - Street 1:164 BALLPARK ROAD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:MO
Practice Address - Zip Code:65582
Practice Address - Country:US
Practice Address - Phone:573-422-6123
Practice Address - Fax:573-422-6328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO125008341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO802056101Medicaid
MO826590494OtherRAILROAD MEDICARE
MO=========OtherCOMMERCIAL
000007076Medicare PIN