Provider Demographics
NPI:1861492563
Name:BARRY-LAWRENCE COUNTY AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:BARRY-LAWRENCE COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANEITTIA
Authorized Official - Middle Name:KAIE
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-235-3102
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:307 DAIRY STREET
Mailing Address - City:MONETT
Mailing Address - State:MO
Mailing Address - Zip Code:65708-0384
Mailing Address - Country:US
Mailing Address - Phone:417-235-3102
Mailing Address - Fax:
Practice Address - Street 1:307 DAIRY ST
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-2520
Practice Address - Country:US
Practice Address - Phone:417-235-3102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0090413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO800628505Medicaid
MO000007165Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER