Provider Demographics
NPI:1912057571
Name:SEMO EMS INC
Entity Type:Organization
Organization Name:SEMO EMS INC
Other - Org Name:BOLLINGER COUNTY EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:573-238-3059
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:MARBLE HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63764-0091
Mailing Address - Country:US
Mailing Address - Phone:573-238-4837
Mailing Address - Fax:573-238-3228
Practice Address - Street 1:RR 2 BOX 2162
Practice Address - Street 2:HWY 34 EAST
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764-9502
Practice Address - Country:US
Practice Address - Phone:573-238-4837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0170513416L0300X
MO0170193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
130913OtherBLUE CROSS BLUE SHIELD
MO806927901Medicaid
MO800461808Medicaid
130913OtherBLUE CROSS BLUE SHIELD
000007821Medicare ID - Type Unspecified