Healthcare Provider Details

I. General information

NPI: 1336217645
Provider Name (Legal Business Name): WEST PECULIAR FIRE PROTECTION DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S MAIN ST
PECULIAR MO
64078-9612
US

IV. Provider business mailing address

200 S MAIN ST
PECULIAR MO
64078-9612
US

V. Phone/Fax

Practice location:
  • Phone: 816-779-5766
  • Fax: 816-779-5769
Mailing address:
  • Phone: 816-779-5766
  • Fax: 816-779-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number037109
License Number StateMO

VIII. Authorized Official

Name: RALPH LOUIS LOAR III
Title or Position: ASSISTANT FIRE CHIEF / EMS MANAGER
Credential: EMT-P
Phone: 816-779-5766