1174651038 NPI number — FORT OSAGE FIRE PROTECTION DIST

Table of content: (NPI 1174651038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174651038 NPI number — FORT OSAGE FIRE PROTECTION DIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORT OSAGE FIRE PROTECTION DIST
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:
1174651038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 747
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60090-0747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-244-2345
Provider Business Mailing Address Fax Number:
800-329-5274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 EAST MONROE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKNER
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64016-0287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-650-5811
Provider Business Practice Location Address Fax Number:
816-650-5819
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YOCUM
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
816-650-5811

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  095117 , 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: 257028&307290 . This is a "HELATHLINK & FIRST GUARD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 257028 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 307290 . This is a "FIRST GUARD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 590005647 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 802121905 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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