Active NPI
Perry County Memorial Hospital
Doing business as Perry County Memorial Hospital Ambulance Service LLC
- Land Ambulance
- Perryville, MO
National Provider Identifier
1407158678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- Legal business name
- PERRY COUNTY MEMORIAL HOSPITAL
- Doing business as
- Perry County Memorial Hospital Ambulance Service LLC
- Practice address
- 201 N. Kingshighway
Perryville, MO 63775 - Phone
- (573) 768-3203
- NPI assigned
- Nov 22, 2010
- Last updated
- Jun 20, 2022
- Organization subpart
- Yes
- Parent organization
- PERRY COUNTY HEALTH SYSTEM DBA PERRY COUNTY MEMORIAL HOSPITAL
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Michael Ellis
- Title
- Cfo
- Phone
- (573) 547-2536
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | NU | Primary |
Addresses
Primary practice location
201 N. Kingshighway
Perryville, MO 63775
Mailing address
434 N West Street
Perryville, MO 63775
Phone (573) 768-3203
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 157007 | Other | MO | MISSOURI DHSS LICENCE |
Other names 1
- PERRY COUNTY MEMORIAL HOSPITAL AMBULANCE SERVICE LLC
National Provider Directory
National Provider Directory- Part of
- Perry County Health System
Locations
201 N Kingshighway St
Perryville, MO 63775
Phone (573) 768-3203
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1290384000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1655683200000",
"number": "1407158678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "434 N WEST STREET",
"city": "PERRYVILLE",
"state": "MO",
"postal_code": "63775",
"telephone_number": "573-768-3203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 N. KINGSHIGHWAY",
"city": "PERRYVILLE",
"state": "MO",
"postal_code": "63775",
"telephone_number": "573-768-3203"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PERRY COUNTY MEMORIAL HOSPITAL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PERRY COUNTY HEALTH SYSTEM DBA PERRY COUNTY MEMORIAL HOSPITAL",
"enumeration_date": "2010-11-22",
"last_updated": "2022-06-20",
"certification_date": "2022-06-15",
"status": "A",
"authorized_official_last_name": "ELLIS",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "573-547-2536",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISSOURI DHSS LICENCE",
"identifier": "157007",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "PERRY COUNTY MEMORIAL HOSPITAL AMBULANCE SERVICE LLC",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "PERRY COUNTY MEMORIAL HOSPITAL AMBULANCE SERVICE LLC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Perryville, MO
- Perry County Health System (Perry County Physician Services)
- Perry County Health System
- Perry County Health System (Perryville Surgical Clinic)
- Perry County Health System (Perry County Memorial Hospital Home Health Care)
- Perry County Health System (Perry County Memorial Hospital)
- Perry County School Dist 32
- Perry County Services, Inc
- Perry County Services, Inc.
- Perry County Sheltered Workshop
- Perry Kids Pediatrics
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.