Provider Demographics
NPI:1033190525
Name:FENTON FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:FENTON FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-343-4188
Mailing Address - Street 1:845 GREGORY LN
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3110
Mailing Address - Country:US
Mailing Address - Phone:636-343-4188
Mailing Address - Fax:636-343-4451
Practice Address - Street 1:845 GREGORY LN
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-3110
Practice Address - Country:US
Practice Address - Phone:636-343-4188
Practice Address - Fax:636-343-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1894303416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
329961OtherHEALTHLINK PROVIDER NO.
125199OtherBCBS PROVIDER NO.
53498OtherGHP PROVIDER NO.
12510OtherHEALTHCAREUSA PROV NO.
8100019OtherUNITED HEALTHCARE PROV. #
889159OtherCOMMUNITY CARE PROV #