Provider Demographics
NPI:1285637058
Name:CITY OF EXCELSIOR SPRINGS
Entity Type:Organization
Organization Name:CITY OF EXCELSIOR SPRINGS
Other - Org Name:EXCELSIOR SPRINGS FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST. CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ST JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-630-3000
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 1:1120 TRACY AVE.
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1141
Practice Address - Country:US
Practice Address - Phone:816-630-3000
Practice Address - Fax:816-630-9530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO047074341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO800548307Medicaid
KS200266320AMedicaid
MO800548307Medicaid