Provider Demographics
NPI:1962466383
Name:BRUCES BODY SHOP INC
Entity Type:Organization
Organization Name:BRUCES BODY SHOP INC
Other - Org Name:MARYSVILLE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:785-562-2359
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:410 N 6TH ST
Mailing Address - City:MARYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66508
Mailing Address - Country:US
Mailing Address - Phone:785-562-2359
Mailing Address - Fax:785-562-3159
Practice Address - Street 1:410 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508
Practice Address - Country:US
Practice Address - Phone:785-562-2359
Practice Address - Fax:785-562-3159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01180341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS112016MAMedicare ID - Type Unspecified