Provider Demographics
NPI:1437289428
Name:CANTON AMBULANCE SERVICE
Entity Type:Organization
Organization Name:CANTON AMBULANCE SERVICE
Other - Org Name:MCPHERSON CO. FIRE DISTRICT 1/ AMB
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-628-4666
Mailing Address - Street 1:201 SOUTH MAIN
Mailing Address - Street 2:P.O. BOX 524
Mailing Address - City:CANTON
Mailing Address - State:KS
Mailing Address - Zip Code:67428
Mailing Address - Country:US
Mailing Address - Phone:620-628-4666
Mailing Address - Fax:620-628-4498
Practice Address - Street 1:201 S MAIN
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:KS
Practice Address - Zip Code:67428
Practice Address - Country:US
Practice Address - Phone:620-628-4666
Practice Address - Fax:620-628-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11903416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200052400BMedicaid
KSKA1163Medicare UPIN
KS200052400BMedicaid