Basic Information
| Provider Information | |||||||||
| NPI: | 1083740245 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKE OZARK FIRE PROTECTION DISTRICT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9150 | ||||||||
| Address2: | |||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420029150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707449600 | ||||||||
| FaxNumber: | 2707448642 | ||||||||
| Practice Location | |||||||||
| Address1: | 1767 BAGNELL DAM BLVD. | ||||||||
| Address2: | |||||||||
| City: | LAKE OZARK | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650499734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733653380 | ||||||||
| FaxNumber: | 5733653758 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2007 | ||||||||
| LastUpdateDate: | 06/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | DORSEY | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 5737450049 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416S0300X | 029050 | MO | N | Transportation Services | Ambulance | Water Transport | 341600000X | 46568 | MO | N | Transportation Services | Ambulance | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 805456100 | 05 | MO | MEDICAID | 149628 | 01 | MO | BLUE CROSS BLUE SHIELD OF | OTHER | HEALTHLINK | 01 | MO | HEALTHLINK | OTHER |