Provider Demographics
NPI:1285718254
Name:TOWN AND COUNTRY AMBULANCE LLC
Entity type:Organization
Organization Name:TOWN AND COUNTRY AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-614-7855
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-0456
Mailing Address - Country:US
Mailing Address - Phone:402-614-7855
Mailing Address - Fax:402-502-8012
Practice Address - Street 1:110 N 2ND ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2246
Practice Address - Country:US
Practice Address - Phone:785-742-3992
Practice Address - Fax:785-742-7268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
005632OtherBC/BS OF KANSAS
KS100374320AMedicaid
KS100374320AMedicaid