Provider Demographics
NPI:1063419620
Name:LINCOLN COUNTY AMB DIST
Entity type:Organization
Organization Name:LINCOLN COUNTY AMB DIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONACCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-295-2186
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-0157
Mailing Address - Country:US
Mailing Address - Phone:636-528-8488
Mailing Address - Fax:636-528-6828
Practice Address - Street 1:1392 SOUTH 3RD ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379
Practice Address - Country:US
Practice Address - Phone:636-528-8488
Practice Address - Fax:636-528-6828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1130003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO800459802Medicaid
MO000007391Medicare PIN