Provider Demographics
NPI:1023146339
Name:EUREKA FIRE PROTECTION DISTRICT OF ST. LOUIS COUNTY
Entity type:Organization
Organization Name:EUREKA FIRE PROTECTION DISTRICT OF ST. LOUIS COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF OF DISTRICT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-935-5505
Mailing Address - Street 1:PO BOX 796008
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-6000
Mailing Address - Country:US
Mailing Address - Phone:636-938-5505
Mailing Address - Fax:636-938-6970
Practice Address - Street 1:4849 HIGHWAY 109
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3737
Practice Address - Country:US
Practice Address - Phone:636-938-5505
Practice Address - Fax:636-938-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1890493416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO590005916OtherMEDICARE - RAILROAD
MO806240305Medicaid
29825OtherBLUE CROSS OF MISSOURI
29825OtherBLUE CROSS OF MISSOURI