Provider Demographics
NPI:1417126822
Name:MEADE, DONALD RAY (EMT-B)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAY
Last Name:MEADE
Suffix:
Gender:M
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2281 BUFORD STREET
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63633
Mailing Address - Country:US
Mailing Address - Phone:573-663-7628
Mailing Address - Fax:
Practice Address - Street 1:2281 BUFORD STREET
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MO
Practice Address - Zip Code:63633
Practice Address - Country:US
Practice Address - Phone:573-663-7628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1790001146L00000X
MO179001146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic