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Organization

CHEROKEE COUNTY AMBULANCE ASSOC. DIST. III

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RONALD JAMES COSTLOW PARAMEDIC (SERVICE DIRECTOR)
(620) 856-2561
Entity
Organization

Contact information

Practice address
311 MILITARY AVENUE, BAXTER SPRINGS, KS 66713-0137
(620) 856-2561
(620) 856-3585
Mailing address
P.O. BOX 137, BAXTER SPRINGS, KS 66713-0137
(620) 856-2561
(620) 856-3585

Taxonomy

Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
300
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
005547
BLUE CROSS/BLUE SHIELD #
KS
05
100091570A
KS
05
100817370A
OK
01
590006034
RAILROAD MEDICARE
KS
05
801647603
MO
Enumeration date
10/03/2006
Last updated
03/11/2013
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