Provider Demographics
NPI:1558362327
Name:VAN FAR AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:VAN FAR AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOTTAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-594-2112
Mailing Address - Street 1:114 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:63382-1813
Mailing Address - Country:US
Mailing Address - Phone:573-594-2112
Mailing Address - Fax:573-594-2624
Practice Address - Street 1:114 E PARK ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:MO
Practice Address - Zip Code:63382-1813
Practice Address - Country:US
Practice Address - Phone:573-594-2112
Practice Address - Fax:573-594-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport