Organization
LINCOLN COUNTY AMB DIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAY ANTONACCI (CHIEF ADMINISTRATOR)
(636) 295-2186
Entity
Organization
Contact information
Practice address
1392 SOUTH 3RD ST, TROY, MO 63379
(636) 528-8488
(636) 528-6828
Mailing address
PO BOX 157, TROY, MO 63379-0157
(636) 528-8488
(636) 528-6828
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
113000
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
800459802
—
MO
Enumeration date
06/28/2005
Last updated
01/07/2020
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