Healthcare Provider Details

I. General information

NPI: 1265415111
Provider Name (Legal Business Name): CITY OF WEBSTER GROVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 S ELM AVE
WEBSTER GROVES MO
63119-3016
US

IV. Provider business mailing address

6 S ELM AVE
WEBSTER GROVES MO
63119-3016
US

V. Phone/Fax

Practice location:
  • Phone: 314-963-5328
  • Fax: 314-962-4504
Mailing address:
  • Phone: 314-963-5328
  • Fax: 314-962-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number189375
License Number StateMO

VIII. Authorized Official

Name: MR. MICHAEL J. CAPRIGLIONE
Title or Position: FIRE CHIEF
Credential:
Phone: 314-963-5328