Provider Demographics
NPI:1245333244
Name:CALDWELL COUNTY AMBULANCE DISTRICT
Entity type:Organization
Organization Name:CALDWELL COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:STILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-586-3801
Mailing Address - Street 1:480 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MO
Mailing Address - Zip Code:64650-9121
Mailing Address - Country:US
Mailing Address - Phone:816-586-3801
Mailing Address - Fax:816-586-4206
Practice Address - Street 1:480 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MO
Practice Address - Zip Code:64650-9121
Practice Address - Country:US
Practice Address - Phone:816-586-3801
Practice Address - Fax:816-586-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0250033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO800461907Medicaid
MO03575011OtherBCBS
MO03575011OtherBCBS