Provider Demographics
NPI:1457327850
Name:PATTONVILLE FIRE PROTECTION DISTRICT
Entity Type:Organization
Organization Name:PATTONVILLE FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVANCHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-739-3118
Mailing Address - Street 1:PO BOX 66711
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63166-6711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13900 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-3826
Practice Address - Country:US
Practice Address - Phone:314-739-3118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1894053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
29843OtherBLUE CROSS BLUE SHIELD
MO11740OtherHEALTHCAREUSA PROVIDER #
8180045OtherUHC PROVIDER #
32822OtherGHP PROVIDER NUMBER
P00220288OtherRR MEDICARE PROVIDER #
106051OtherHEALTHLINK PROVIDER #