Lincoln County Amb Dist

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

113000 Issued in MO

Legal business name

LINCOLN COUNTY AMB DIST

Practice address

1392 South 3Rd St
Troy, MO 63379

Phone

(636) 528-8488

Fax

(636) 528-6828

NPI assigned

Jun 28, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ray Antonacci

Title

Chief Administrator

Phone

(636) 295-2186

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578355200000",
    "number": "1063419620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 157",
            "city": "TROY",
            "state": "MO",
            "postal_code": "633790157",
            "telephone_number": "636-528-8488",
            "fax_number": "636-528-6828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1392 SOUTH 3RD ST",
            "city": "TROY",
            "state": "MO",
            "postal_code": "63379",
            "telephone_number": "636-528-8488",
            "fax_number": "636-528-6828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN COUNTY AMB DIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-28",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A",
        "authorized_official_last_name": "ANTONACCI",
        "authorized_official_first_name": "RAY",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATOR",
        "authorized_official_telephone_number": "636-295-2186",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "MO",
            "license": "113000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "800459802",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Justin Clarke Liedke, PHARM.D.
• Life Restoration Center
• Madysen Taylar Lilley, FNP-BC
• Lincare Inc.
• Adrienne Linck
• Lincoln County Chiropractic LLC
• Lincoln County Health Department
• Lincoln County Medicine & Pediatrics, LLC
• Lincoln County Memorial Hospital
• Lincoln County Memorial Hospital

• Land Ambulance in Troy, MO
• Providers in Troy, MO by specialty
• Land Ambulance in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.