Provider Demographics
NPI:1063584506
Name:EAST WAYNE COUNTY AMBULANCE DISTRICT
Entity type:Organization
Organization Name:EAST WAYNE COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER/BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIDINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-224-5501
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63944-0173
Mailing Address - Country:US
Mailing Address - Phone:573-224-5501
Mailing Address - Fax:573-224-5348
Practice Address - Street 1:105 SYCAMORE ST.
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MO
Practice Address - Zip Code:63944
Practice Address - Country:US
Practice Address - Phone:573-224-5501
Practice Address - Fax:573-224-5348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2230343416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO802414607Medicaid