Provider Demographics
NPI:1053415265
Name:WORTH COUNTY AMBULANCE SERVICE
Entity type:Organization
Organization Name:WORTH COUNTY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC TREAS
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-786-2351
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:GRANT CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64456
Mailing Address - Country:US
Mailing Address - Phone:660-786-2351
Mailing Address - Fax:660-786-2331
Practice Address - Street 1:503 EAST 4TH STREET
Practice Address - Street 2:
Practice Address - City:GRANT CITY
Practice Address - State:MO
Practice Address - Zip Code:64456
Practice Address - Country:US
Practice Address - Phone:660-786-2351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO801352204Medicaid
27766015OtherBCBS