Provider Demographics
NPI:1396790218
Name:ST. CHARLES COUNTY AMBULANCE DISTRICT
Entity type:Organization
Organization Name:ST. CHARLES COUNTY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, FACHE
Authorized Official - Phone:636-344-7681
Mailing Address - Street 1:2000 SALT RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3956
Mailing Address - Country:US
Mailing Address - Phone:636-344-7600
Mailing Address - Fax:636-447-9060
Practice Address - Street 1:2000 SALT RIVER RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-3956
Practice Address - Country:US
Practice Address - Phone:636-344-7600
Practice Address - Fax:636-447-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
MO3416L0300X
MO1830323416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
29623OtherBLUE CHOICE
32950OtherCARE MNGMNT RESOURCES
025920170OtherAETNA
108458OtherHEALTHLINK
32950OtherADVANTRA MEDICARE HMO
MO800463507Medicaid
622786OtherTRIGON BLUE CROSS
999135OtherCOMMUNITY CARE MC
32950OtherGROUP HEALTH PLAN
29623OtherBLUE CROSS
32950OtherGOLD ADVANTAGE
29623OtherBLUE CHOICE
32950OtherGROUP HEALTH PLAN
32950OtherGOLD ADVANTAGE
622786OtherTRIGON BLUE CROSS
622786OtherTRIGON BLUE CROSS
000=========OtherMERCY HEALTH PLAN HMO
000=========OtherMERCY HEALTH PLAN MC+