Provider Demographics
NPI:1346229499
Name:VERNON COUNTY AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:VERNON COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:417-667-5079
Mailing Address - Street 1:515 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:MO
Mailing Address - Zip Code:64772-2630
Mailing Address - Country:US
Mailing Address - Phone:417-667-5079
Mailing Address - Fax:417-667-6097
Practice Address - Street 1:515 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:MO
Practice Address - Zip Code:64772-2630
Practice Address - Country:US
Practice Address - Phone:417-667-5079
Practice Address - Fax:417-667-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2170343416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9005901Medicare ID - Type Unspecified