Provider Demographics
NPI:1013961259
Name:RAY COUNTY AMBULANCE DISTRICT
Entity type:Organization
Organization Name:RAY COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-470-3030
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MO
Mailing Address - Zip Code:64085-0514
Mailing Address - Country:US
Mailing Address - Phone:816-470-3030
Mailing Address - Fax:
Practice Address - Street 1:208 WOLLARD BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MO
Practice Address - Zip Code:64085-1928
Practice Address - Country:US
Practice Address - Phone:816-470-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO177083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO802049908Medicaid
MO11428016OtherBLUE CROSS
MO9006657Medicare ID - Type Unspecified