Provider Demographics
NPI:1174643332
Name:KNOX COUNTY AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:KNOX COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLLERK
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-215-2447
Mailing Address - Street 1:100 CHERRY STREET
Mailing Address - Street 2:P.O. BOX 185
Mailing Address - City:LEWISTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63452-9680
Mailing Address - Country:US
Mailing Address - Phone:573-215-2447
Mailing Address - Fax:573-215-2406
Practice Address - Street 1:610 EAST LAFAYETTE STREET
Practice Address - Street 2:RR3 BOX 30A
Practice Address - City:EDINA
Practice Address - State:MO
Practice Address - Zip Code:63537
Practice Address - Country:US
Practice Address - Phone:660-397-2280
Practice Address - Fax:660-397-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103004341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO157763OtherBC BS PROVIDER