Organization
PULASKI COUNTY AMBULANCE DISTRICT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDALL MOORE RN (ADMINISTRATOR/CHIEF)
(573) 774-5413
Entity
Organization
Contact information
Practice address
1601 OUSLEY RD, WAYNESVILLE, MO 65583-3532
(573) 774-5413
(573) 774-2748
Mailing address
PO BOX 466, WAYNESVILLE, MO 65583-0466
(573) 774-2807
(573) 774-2748
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
169030
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000007326
MEDICARE PTAN
MO
05
—
802454108
—
MO
Enumeration date
07/12/2006
Last updated
02/06/2025
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