Healthcare Provider Details

I. General information

NPI: 1063323640
Provider Name (Legal Business Name): FLORISSANT VALLEY FIRE PRO DIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 SAINT FERDINAND ST
FLORISSANT MO
63031-5124
US

IV. Provider business mailing address

661 SAINT FERDINAND ST
FLORISSANT MO
63031-5124
US

V. Phone/Fax

Practice location:
  • Phone: 800-538-8278
  • Fax:
Mailing address:
  • Phone: 800-538-8278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146E00000X
TaxonomyCommunity Paramedic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARK A. FLAUTER
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 314-837-4894