Provider Demographics
NPI:1194929240
Name:EAST CARTER COUNTY VOLUNTEER AMBULANCE
Entity type:Organization
Organization Name:EAST CARTER COUNTY VOLUNTEER AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER CREW CHIEF
Authorized Official - Prefix:MS
Authorized Official - First Name:ERMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:573-322-8303
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:RT.2 BOX 2004
Mailing Address - City:ELLSINORE
Mailing Address - State:MO
Mailing Address - Zip Code:63937-0160
Mailing Address - Country:US
Mailing Address - Phone:573-322-8303
Mailing Address - Fax:573-322-8303
Practice Address - Street 1:RT. 2 BOX 2004
Practice Address - Street 2:SOUTH SIDE HWY. A AT WEST CITY LIMITS
Practice Address - City:ELLSINORE
Practice Address - State:MO
Practice Address - Zip Code:63937-0160
Practice Address - Country:US
Practice Address - Phone:573-322-8303
Practice Address - Fax:573-322-8303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO4595341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO800628109Medicaid
MO000006935Medicare ID - Type Unspecified
MO800628109Medicaid