Provider Demographics
NPI:1609838630
Name:LEWIS COUNTY AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:LEWIS COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-215-2447
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:100 CHERRY STREET
Mailing Address - City:LEWISTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63452-0218
Mailing Address - Country:US
Mailing Address - Phone:573-215-2447
Mailing Address - Fax:573-215-2406
Practice Address - Street 1:100 CHERRY STREET
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MO
Practice Address - Zip Code:63452-0218
Practice Address - Country:US
Practice Address - Phone:573-215-2447
Practice Address - Fax:573-215-2406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111007341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO157388OtherBCBS MO