Provider Demographics
NPI:1932111259
Name:WARREN COUNTY AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:WARREN COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:V
Authorized Official - Last Name:HELLEBUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-456-8413
Mailing Address - Street 1:604 FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-4420
Mailing Address - Country:US
Mailing Address - Phone:636-456-8413
Mailing Address - Fax:636-456-1147
Practice Address - Street 1:604 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-4420
Practice Address - Country:US
Practice Address - Phone:636-456-8413
Practice Address - Fax:636-456-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2190293416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9000Medicaid
MO1073897Medicaid
MO29687OtherANTHEM BLUE SHIELD
MO238896OtherHEALTHLINK