Provider Demographics
NPI:1194792861
Name:NEWTON COUNTY AMBULANCE DISTRICT
Entity type:Organization
Organization Name:NEWTON COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:TINNNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:417-451-5568
Mailing Address - Street 1:1011 W HILL ST
Mailing Address - Street 2:PO BOX 60
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-0060
Mailing Address - Country:US
Mailing Address - Phone:417-451-5568
Mailing Address - Fax:417-451-5573
Practice Address - Street 1:1011 W HILL ST
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850
Practice Address - Country:US
Practice Address - Phone:417-451-5568
Practice Address - Fax:417-451-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO145009341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO8004642008Medicaid
MO90003Medicare ID - Type Unspecified
MO8004642008Medicaid