Provider Demographics
NPI:1710012778
Name:STEELVILLE AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:STEELVILLE AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:PATT
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:573-775-2211
Mailing Address - Street 1:PO BOX 541
Mailing Address - Street 2:#1 EMS LANE
Mailing Address - City:STEELVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65565-0541
Mailing Address - Country:US
Mailing Address - Phone:573-775-2211
Mailing Address - Fax:573-775-3982
Practice Address - Street 1:#1 EMS LANE
Practice Address - Street 2:
Practice Address - City:STEELVILLE
Practice Address - State:MO
Practice Address - Zip Code:65565
Practice Address - Country:US
Practice Address - Phone:573-775-2211
Practice Address - Fax:573-775-3982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO800630006Medicaid
MO000006815Medicare ID - Type Unspecified