Provider Demographics
NPI:1922001254
Name:REV NOEL T ADAMS MEM AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:REV NOEL T ADAMS MEM AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF EMS
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARCLAY
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:660-425-6319
Mailing Address - Street 1:1000 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:MO
Mailing Address - Zip Code:64424-2610
Mailing Address - Country:US
Mailing Address - Phone:660-425-6319
Mailing Address - Fax:660-425-7019
Practice Address - Street 1:1000 S 25TH ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:MO
Practice Address - Zip Code:64424-2610
Practice Address - Country:US
Practice Address - Phone:660-425-6319
Practice Address - Fax:660-425-7019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0810013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO801371303Medicaid
MO826590263OtherRAILROAD MEDICARE
MO03743015OtherBLUE CROSS BLUE SHIELD
MO9005561Medicare ID - Type UnspecifiedPROVIDER NUMBER