Provider Demographics
NPI:1477660181
Name:METRO WEST FIRE PROTECTION DISTRICT OF ST LOUIS CITY
Entity Type:Organization
Organization Name:METRO WEST FIRE PROTECTION DISTRICT OF ST LOUIS CITY
Other - Org Name:METRO WEST FIRE PROTECTION DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-821-5807
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-0310
Mailing Address - Country:US
Mailing Address - Phone:636-458-2100
Mailing Address - Fax:
Practice Address - Street 1:17065 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1111
Practice Address - Country:US
Practice Address - Phone:636-458-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========OtherTRICARE WEST
MO000006218Medicare PIN