Provider Demographics
NPI:1700855392
Name:CITY OF DES PERES
Entity Type:Organization
Organization Name:CITY OF DES PERES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-835-6231
Mailing Address - Street 1:12325 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4316
Mailing Address - Country:US
Mailing Address - Phone:314-835-6113
Mailing Address - Fax:
Practice Address - Street 1:1000 N BALLAS RD
Practice Address - Street 2:
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-3706
Practice Address - Country:US
Practice Address - Phone:314-822-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1892013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
29933OtherGHP PROVIDER NO.
MO805146701Medicaid
P00140402OtherRAILROAD MEDICARE PROV. #
8181789OtherUNITED HEALTHCARE PROV. #
127801OtherBLUE CROSS PROVIDER NO.
MO19819OtherHEALTHCAREUSA PROVIDER #
P00140402OtherRAILROAD MEDICARE PROV. #