Provider Demographics
NPI:1588672133
Name:NEW HAVEN AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:NEW HAVEN AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-237-3519
Mailing Address - Street 1:110 INDUSTRIAL DR
Mailing Address - Street 2:P.O.BOX 167
Mailing Address - City:NEW HAVEN
Mailing Address - State:MO
Mailing Address - Zip Code:63068-1303
Mailing Address - Country:US
Mailing Address - Phone:573-237-3519
Mailing Address - Fax:573-237-4627
Practice Address - Street 1:110 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MO
Practice Address - Zip Code:63068-1303
Practice Address - Country:US
Practice Address - Phone:573-237-3519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0710723416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO8493Medicaid
MO800461006Medicaid
MO800461006Medicaid