Provider Demographics
NPI:1669597712
Name:ATCHISON HOLT AMBULANCE DISTRICT
Entity type:Organization
Organization Name:ATCHISON HOLT AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DYMOND
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:EMTP
Authorized Official - Phone:660-736-5216
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:TARKIO
Mailing Address - State:MO
Mailing Address - Zip Code:64491
Mailing Address - Country:US
Mailing Address - Phone:660-736-5216
Mailing Address - Fax:660-744-6066
Practice Address - Street 1:303 S 3RD ST
Practice Address - Street 2:
Practice Address - City:TARKIO
Practice Address - State:MO
Practice Address - Zip Code:64491-1808
Practice Address - Country:US
Practice Address - Phone:660-736-5216
Practice Address - Fax:660-736-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005002146L00000X
MO5002341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes341600000XTransportation ServicesAmbulance
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO800492506Medicaid
MO800492506Medicaid
MO826590363Medicare PIN