Provider Demographics
NPI:1760446660
Name:REYNOLDS COUNTY AMBULANCE CENTERVILLE BASE
Entity Type:Organization
Organization Name:REYNOLDS COUNTY AMBULANCE CENTERVILLE BASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:KAEMPFE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:573-648-8009
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63633-0052
Mailing Address - Country:US
Mailing Address - Phone:573-648-8009
Mailing Address - Fax:573-648-2546
Practice Address - Street 1:2281 BUFORD ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MO
Practice Address - Zip Code:63633-0052
Practice Address - Country:US
Practice Address - Phone:573-648-8009
Practice Address - Fax:573-648-2546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1790013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport