1700855392 NPI number — CITY OF DES PERES

Table of content: (NPI 1700855392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700855392 NPI number — CITY OF DES PERES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF DES PERES
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:
1700855392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12325 MANCHESTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63131-4316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-835-6113
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 N BALLAS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES PERES
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63131-3706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-822-1500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FIALA
Authorized Official First Name:
DALE
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT FIRE CHIEF
Authorized Official Telephone Number:
314-835-6231

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  189201 , 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: 29933 . This is a "GHP PROVIDER NO." identifier . This identifiers is of the category "OTHER".
  • Identifier: 805146701 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00140402 . This is a "RAILROAD MEDICARE PROV. #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8181789 . This is a "UNITED HEALTHCARE PROV. #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 127801 . This is a "BLUE CROSS PROVIDER NO." identifier . This identifiers is of the category "OTHER".
  • Identifier: 19819 . This is a "HEALTHCAREUSA PROVIDER #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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