Provider Demographics
NPI:1144025107
Name:MINGO, ANTHONY J (EMT-CP, CHW-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:MINGO
Suffix:
Gender:M
Credentials:EMT-CP, CHW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 BILL GUM BUSINESS BLVD
Mailing Address - Street 2:
Mailing Address - City:MINERAL POINT
Mailing Address - State:MO
Mailing Address - Zip Code:63660-9253
Mailing Address - Country:US
Mailing Address - Phone:573-438-3635
Mailing Address - Fax:573-438-3665
Practice Address - Street 1:6900 BILL GUM BUSINESS BLVD
Practice Address - Street 2:
Practice Address - City:MINERAL POINT
Practice Address - State:MO
Practice Address - Zip Code:63660-9253
Practice Address - Country:US
Practice Address - Phone:573-438-3635
Practice Address - Fax:573-438-3665
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO174H00000X
MO17201172V00000X
MOCP-18785146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No174H00000XOther Service ProvidersHealth Educator
No172V00000XOther Service ProvidersCommunity Health Worker