=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033190525
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FENTON FIRE PROTECTION DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2005
-----------------------------------------------------
Last Update Date | 02/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 845 GREGORY LN
-----------------------------------------------------
City | FENTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63026-3110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-343-4188
-----------------------------------------------------
Fax | 636-343-4451
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 845 GREGORY LN
-----------------------------------------------------
City | FENTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63026-3110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-343-4188
-----------------------------------------------------
Fax | 636-343-4451
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | KIMBERLY SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 636-343-4188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 189430
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------