City of Cherryvale
Organization Active NPI Land Ambulance · Cherryvale, KS
NPI 1720187461 · NPPES record last updated Jul 8, 2008
Key facts
- NPI
- 1720187461
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 310 (KS)
- Legal business name
- CITY OF CHERRYVALE
- Practice address
- 116 S Neosho St
Cherryvale, KS 67335-2018 - Phone
- (800) 538-8278
- Fax
- (580) 628-2273
- NPI assigned
- Sep 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Ron Davis
- Title
- Ambulance Director
- Phone
- (620) 336-2121
Practitioners 1
-
Jesse Eli Reed, RN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0689170 | Cherryvale Emergency Service | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040119000423 | KS | Part B Supplier - Ambulance Service Supplier | 1759282171 | Practice locations: Cherryvale, KS |
National Provider Directory
Locations
116 S Neosho St
Cherryvale, KS 67335
Phone (620) 336-2121
123 W Main St
Cherryvale, KS 67335
Phone (620) 336-2121
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 310 | KS | Yes |
Addresses
Primary practice location
116 S Neosho St
Cherryvale, KS 67335-2018
Mailing address
123 W Main St
Cherryvale, KS 67335-1321
Phone (800) 538-8278
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000005661 | Other | KS | BCBS PROVIDER NUMBER |
| 100091850A | Medicaid | KS |
Other names
- Cherryvale Emergency Service
Other providers in Cherryvale, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2008. 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.