Provider Demographics
NPI:1760630032
Name:MADISON COUNTY AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:MADISON COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-783-7900
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-0492
Mailing Address - Country:US
Mailing Address - Phone:573-783-2552
Mailing Address - Fax:
Practice Address - Street 1:126 RIVER BLUFF DR
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-6364
Practice Address - Country:US
Practice Address - Phone:573-783-7900
Practice Address - Fax:573-783-5456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPENDING341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance