Provider Demographics
NPI:1295797744
Name:CITY OF LADUE
Entity type:Organization
Organization Name:CITY OF LADUE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:JURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-993-0181
Mailing Address - Street 1:9213 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:LADUE
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1509
Mailing Address - Country:US
Mailing Address - Phone:314-993-0181
Mailing Address - Fax:314-993-0412
Practice Address - Street 1:9213 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:LADUE
Practice Address - State:MO
Practice Address - Zip Code:63124-1509
Practice Address - Country:US
Practice Address - Phone:314-993-0181
Practice Address - Fax:314-993-0412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1890813416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
000009147Medicare ID - Type Unspecified