Provider Demographics
NPI:1558340877
Name:CLARK COUNTY AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:CLARK COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDA
Authorized Official - Middle Name:I
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-727-3612
Mailing Address - Street 1:211 N VINE ST
Mailing Address - Street 2:
Mailing Address - City:KAHOKA
Mailing Address - State:MO
Mailing Address - Zip Code:63445-1283
Mailing Address - Country:US
Mailing Address - Phone:660-727-3612
Mailing Address - Fax:660-727-2182
Practice Address - Street 1:211 N VINE ST
Practice Address - Street 2:
Practice Address - City:KAHOKA
Practice Address - State:MO
Practice Address - Zip Code:63445-1283
Practice Address - Country:US
Practice Address - Phone:660-727-3612
Practice Address - Fax:660-727-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0450043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO155574OtherBC/BS OF MISSOURI
IAITS99OtherWELLMARK BC/BS OF IOWA
IA0906834Medicaid
IAITS99OtherWELLMARK BC/BS OF IOWA