Pulaski County Ambulance District

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

169030 Issued in MO

Legal business name

PULASKI COUNTY AMBULANCE DISTRICT

Practice address

1601 Ousley Rd
Waynesville, MO 65583-3532

Phone

(573) 774-5413

Fax

(573) 774-2748

NPI assigned

Jul 12, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Randall Moore, RN

Title

Administrator/Chief

Phone

(573) 774-5413

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738800000000",
    "number": "1710912381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 466",
            "city": "WAYNESVILLE",
            "state": "MO",
            "postal_code": "655830466",
            "telephone_number": "573-774-2807",
            "fax_number": "573-774-2748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 OUSLEY RD",
            "city": "WAYNESVILLE",
            "state": "MO",
            "postal_code": "655833532",
            "telephone_number": "573-774-5413",
            "fax_number": "573-774-2748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PULASKI COUNTY AMBULANCE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2025-02-06",
        "certification_date": "2025-02-06",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "ADMINISTRATOR/CHIEF",
        "authorized_official_telephone_number": "573-774-5413",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "MO",
            "license": "169030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "802454108",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "000007326",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Phelps County Regional Medical Center
• Johnna Pitts, 2017002215
• Tonya Powell, LPC
• Melodie Prater, LPC
• Billie Pratt, SLP
• Pulaski County Board for the Handicapped
• Pulaski County Health Department
• Charles L Quinn
• Karolina Radziwillowicz
• Maegan Ramsey

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.