MEDICARE: CITY OF ST CHARLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	183016	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590155547	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184621799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF ST CHARLES

Provider Business Mailing Address
First Line	:	3201 BOSCHERTOWN RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-3202
Country	:	US
Telephone Number	:	636-949-3250
Fax Number	:	636-896-4305

Provider Business Practice Location Address
First Line	:	3201 BOSCHERTOWN RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-3202
Country	:	US
Telephone Number	:	636-949-3250
Fax Number	:	636-949-3297

Authorized Official
Title or Position	:	EMS BUREAU CHIEF
Name	:	MARC R DOLL
Credential	:
Telephone Number	:	636-949-3250

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	03/17/2023

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Directions to “CITY OF ST CHARLES ” Practice Location

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