1033190525 NPI number — FENTON FIRE PROTECTION DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033190525 NPI number — FENTON FIRE PROTECTION DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FENTON FIRE PROTECTION DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033190525
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
845 GREGORY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FENTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63026-3110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-343-4188
Provider Business Mailing Address Fax Number:
636-343-4451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 GREGORY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FENTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63026-3110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-343-4188
Provider Business Practice Location Address Fax Number:
636-343-4451
Provider Enumeration Date:
11/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
636-343-4188

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  189430 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12510 . This is a "HEALTHCAREUSA PROV NO." identifier . This identifiers is of the category "OTHER".
  • Identifier: 329961 . This is a "HEALTHLINK PROVIDER NO." identifier . This identifiers is of the category "OTHER".
  • Identifier: 590014622 . This is a "RAILROAD MEDICARE PROV #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 889159 . This is a "COMMUNITY CARE PROV #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 125199 . This is a "BCBS PROVIDER NO." identifier . This identifiers is of the category "OTHER".
  • Identifier: 53498 . This is a "GHP PROVIDER NO." identifier . This identifiers is of the category "OTHER".
  • Identifier: 8100019 . This is a "UNITED HEALTHCARE PROV. #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 808538003 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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