Cherokee County Ambulance Assoc. Dist. III

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

300 Issued in KS

Legal business name

CHEROKEE COUNTY AMBULANCE ASSOC. DIST. III

Practice address

311 Military Avenue
Baxter Springs, KS 66713-0137

Phone

(620) 856-2561

Fax

(620) 856-3585

NPI assigned

Oct 3, 2006

Last updated

Mar 11, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Ronald James Costlow, PARAMEDIC

Title

Service Director

Phone

(620) 856-2561

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362960000000",
    "number": "1376637157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 137",
            "city": "BAXTER SPRINGS",
            "state": "KS",
            "postal_code": "667130137",
            "telephone_number": "620-856-2561",
            "fax_number": "620-856-3585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 MILITARY AVENUE",
            "city": "BAXTER SPRINGS",
            "state": "KS",
            "postal_code": "667130137",
            "telephone_number": "620-856-2561",
            "fax_number": "620-856-3585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHEROKEE COUNTY AMBULANCE ASSOC. DIST. III",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2013-03-11",
        "status": "A",
        "authorized_official_last_name": "COSTLOW",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "SERVICE DIRECTOR",
        "authorized_official_telephone_number": "620-856-2561",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PARAMEDIC"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "KS",
            "license": "300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100817370A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "801647603",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD #",
            "identifier": "005547",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590006034",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100091570A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.