Provider Demographics
NPI:1467770438
Name:CITY OF FRONTENAC
Entity Type:Organization
Organization Name:CITY OF FRONTENAC
Other - Org Name:FRONTENAC FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:TROUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-373-6520
Mailing Address - Street 1:3763 SOLUTIONS DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0001
Mailing Address - Country:US
Mailing Address - Phone:937-291-2892
Mailing Address - Fax:
Practice Address - Street 1:10555 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:FRONTENAC
Practice Address - State:MO
Practice Address - Zip Code:63131-2915
Practice Address - Country:US
Practice Address - Phone:314-373-6520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO189473341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance