Provider Demographics
NPI:1477550937
Name:DEKALB CLINTON AMBULANCE DISTRICT NO 1
Entity Type:Organization
Organization Name:DEKALB CLINTON AMBULANCE DISTRICT NO 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-669-3642
Mailing Address - Street 1:261 SE OFFUTT RD
Mailing Address - Street 2:PO BOX 501
Mailing Address - City:MAYSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64469-9149
Mailing Address - Country:US
Mailing Address - Phone:816-669-3642
Mailing Address - Fax:816-669-3642
Practice Address - Street 1:261 SE OFFUTT RD
Practice Address - Street 2:PO 501
Practice Address - City:MAYSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64469-9149
Practice Address - Country:US
Practice Address - Phone:816-669-3642
Practice Address - Fax:816-669-3642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0630023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT02666154OtherVA CHAMPUS
MO08167011OtherBLUE CROSS BLUE SHIELD
MO590077838AOtherRAILROAD MEDICARE
MO590077838AOtherRAILROAD MEDICARE