Provider Demographics
NPI:1982760179
Name:COMMUNITY AMBULANCE DISTRICT
Entity type:Organization
Organization Name:COMMUNITY AMBULANCE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-663-3809
Mailing Address - Street 1:204 E CORRINE ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:MO
Mailing Address - Zip Code:64640-1006
Mailing Address - Country:US
Mailing Address - Phone:660-663-3809
Mailing Address - Fax:660-663-3809
Practice Address - Street 1:204 E CORRINE ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:MO
Practice Address - Zip Code:64640-1006
Practice Address - Country:US
Practice Address - Phone:660-663-3809
Practice Address - Fax:660-663-3809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO061000146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO03467013OtherBLUE CROSS BLUE SHIELD
MO03467013OtherBLUE CROSS BLUE SHIELD