Provider Demographics
NPI:1629165246
Name:COUNTY OF GRUNDY
Entity Type:Organization
Organization Name:COUNTY OF GRUNDY
Other - Org Name:GRUNDY COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AMBULANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-359-4422
Mailing Address - Street 1:1001 E 17TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-1959
Mailing Address - Country:US
Mailing Address - Phone:660-359-4422
Mailing Address - Fax:660-359-4057
Practice Address - Street 1:1001 E 17TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-1959
Practice Address - Country:US
Practice Address - Phone:660-359-4422
Practice Address - Fax:660-359-4057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO079006341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO80062024Medicaid
MO590077729OtherRAILROAD RETIREMENT
MO03652018OtherBLUE CROSS BLUE SHIELD
MO80062024Medicaid