Healthcare Provider Details

I. General information

NPI: 1235110792
Provider Name (Legal Business Name): AFFTON FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9282 GRAVOIS RD
AFFTON MO
63123-4526
US

IV. Provider business mailing address

2840 RELIABLE PARKWAY
CHICAGO IL
60686-0001
US

V. Phone/Fax

Practice location:
  • Phone: 314-631-1803
  • Fax: 314-353-7679
Mailing address:
  • Phone: 314-631-1803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number189413
License Number StateMO

VIII. Authorized Official

Name: JOHN F RAUSCH
Title or Position: FIRE CHIEF
Credential:
Phone: 314-631-1803