Provider Demographics
NPI:1942390638
Name:CHEROKEE COUNTY AMBULANCE ASSOCIATION INC.
Entity Type:Organization
Organization Name:CHEROKEE COUNTY AMBULANCE ASSOCIATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-429-3018
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:KS
Mailing Address - Zip Code:66725-0307
Mailing Address - Country:US
Mailing Address - Phone:620-429-3018
Mailing Address - Fax:620-429-1352
Practice Address - Street 1:800 W POWRACHUTE WAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:KS
Practice Address - Zip Code:66725-9701
Practice Address - Country:US
Practice Address - Phone:620-429-3018
Practice Address - Fax:620-429-1352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS290341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000005861OtherBCBS OF KS
KS100092260AMedicaid
KS0000005861OtherBCBS OF KS