Provider Demographics
NPI:1174670483
Name:NORTH CRAWFORD CO AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:NORTH CRAWFORD CO AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-885-3793
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-0523
Mailing Address - Country:US
Mailing Address - Phone:573-885-3793
Mailing Address - Fax:573-885-2077
Practice Address - Street 1:101 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-7339
Practice Address - Country:US
Practice Address - Phone:573-885-3793
Practice Address - Fax:573-885-2077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO801179706Medicaid
MO801179706Medicaid