Provider Demographics
NPI:1881743540
Name:CONCORDIA FIRE PROTECTION DIST INC
Entity type:Organization
Organization Name:CONCORDIA FIRE PROTECTION DIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC-TREAS.
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WULSER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:660-463-7900
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:MO
Mailing Address - Zip Code:64020-0121
Mailing Address - Country:US
Mailing Address - Phone:660-463-7900
Mailing Address - Fax:660-463-2770
Practice Address - Street 1:710 S. ORANGE ST.
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:MO
Practice Address - Zip Code:64020-0121
Practice Address - Country:US
Practice Address - Phone:660-463-7900
Practice Address - Fax:660-463-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO10700341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO03470013OtherBLUE CROSS BLUE SHIELD
MO800628901Medicaid
MO9004218Medicare ID - Type Unspecified