Healthcare Provider Details

I. General information

NPI: 1033190525
Provider Name (Legal Business Name): FENTON FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 GREGORY LN
FENTON MO
63026-3110
US

IV. Provider business mailing address

845 GREGORY LN
FENTON MO
63026-3110
US

V. Phone/Fax

Practice location:
  • Phone: 636-343-4188
  • Fax: 636-343-4451
Mailing address:
  • Phone: 636-343-4188
  • Fax: 636-343-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number189430
License Number StateMO

VIII. Authorized Official

Name: KIMBERLY SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 636-343-4188