Provider Demographics
NPI:1851593479
Name:COOPER COUNTY AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:COOPER COUNTY AMBULANCE DISTRICT
Other - Org Name:COOPER COUNTY MEMORIAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-882-4105
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233
Mailing Address - Country:US
Mailing Address - Phone:660-882-4105
Mailing Address - Fax:660-882-8108
Practice Address - Street 1:17651 B HIGHWAY
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233
Practice Address - Country:US
Practice Address - Phone:660-882-4105
Practice Address - Fax:660-882-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO24836341600000X
MO0530073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA5099Medicare PIN
MO260004Medicare ID - Type UnspecifiedAMBULANCE