Provider Demographics
NPI:1700883253
Name:VALLE AMBULANCE DISTRICT
Entity type:Organization
Organization Name:VALLE AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC P-15066
Authorized Official - Phone:636-586-2132
Mailing Address - Street 1:12363 STATE ROUTE 21
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:MO
Mailing Address - Zip Code:63020
Mailing Address - Country:US
Mailing Address - Phone:636-586-2132
Mailing Address - Fax:636-586-4436
Practice Address - Street 1:12363 STATE ROUTE 21
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020
Practice Address - Country:US
Practice Address - Phone:636-586-2132
Practice Address - Fax:636-586-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0990823416L0300X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO800464000Medicaid
MO800464000Medicaid