MEDICARE: WEST OVERLAND FIRE PROTECTION DIST OF ST LOUIS COUNTY

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	189189	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	590012870	OTHER		RAILROAD MEDICARE PROV #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	33608	OTHER	GHP PROVIDER NO.
2	8181099	OTHER	UNITED HEALTHCARE PROV #
4	119728	OTHER	BCBS PROVIDER NO.
5	9019	OTHER	HEALTHCAREUSA PROVIDER NO
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871577411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST OVERLAND FIRE PROTECTION DIST OF ST LOUIS COUNTY

Provider Business Mailing Address
First Line	:	PO BOX 501157
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63150-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10789 MIDLAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63114-1839
Country	:	US
Telephone Number	:	314-428-6069
Fax Number	:	314-428-3114

Authorized Official
Title or Position	:	CHIEF
Name	:	MICHAEL MARLO
Credential	:
Telephone Number	:	314-428-6069

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	05/01/2013

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Directions to “WEST OVERLAND FIRE PROTECTION DIST OF ST LOUIS COUNTY ” Practice Location

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