Provider Demographics
NPI:1578671616
Name:CALLAWAY COUNTY AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:CALLAWAY COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:573-642-7260
Mailing Address - Street 1:2614 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-4018
Mailing Address - Country:US
Mailing Address - Phone:573-642-7260
Mailing Address - Fax:573-642-4069
Practice Address - Street 1:2614 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-4018
Practice Address - Country:US
Practice Address - Phone:573-642-7260
Practice Address - Fax:573-642-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0270063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO800462004Medicaid