Carroll County Ambulance District
Organization Active NPI Ambulance · Carrollton, MO
NPI 1508859331 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1508859331
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulance 341600000X
- License
- 033014 (MO)
- Legal business name
- CARROLL COUNTY AMBULANCE DISTRICT
- Practice address
- 603 N Mason St
Carrollton, MO 64633-2252 - Phone
- (660) 542-1808
- Fax
- (660) 542-1072
- NPI assigned
- Aug 26, 2005
- Organization subpart
- No
Authorized official
- Name
- Ms. Sheri Clavin, EMTP
- Title
- Administrator
- Phone
- (660) 542-1808
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D0864613 | Carroll County Ambulance District | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110511000380 | MO | Part B Supplier - Ambulance Service Supplier | 3678759545 | Practice locations: Carrollton, MO |
National Provider Directory
Locations
603 N Mason St
Carrollton, MO 64633
Phone (660) 542-1808
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 033014 | MO | Yes |
Addresses
Primary practice location
603 N Mason St
Carrollton, MO 64633-2252
Mailing address
603 N Mason St
P.O. Box 511
Carrollton, MO 64633-2252
Phone (660) 542-1808
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100472 | Other | MO | EDI |
| 03576019 | Other | MO | BLUE CROSS BLUE SHIELD |
| 10K4112 | Other | MO | BCBS OF MO |
Other providers in Carrollton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.