Provider Demographics
NPI:1154321040
Name:CHARITON COUNTY AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:CHARITON COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-388-6115
Mailing Address - Street 1:212 SOUTH WEBER AVE.
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MO
Mailing Address - Zip Code:65281
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 S WEBER AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MO
Practice Address - Zip Code:65281-1014
Practice Address - Country:US
Practice Address - Phone:660-388-6115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041009146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO800628802Medicaid
MO800628802Medicaid