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General NPI Number Information
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NPI Number | 1588345433
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Entity Type | Organization
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Legal Business Name | CITY OF CRESTWOOD
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Dates
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Enumeration Date | 07/25/2023
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 1 DETJEN DR
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City | SAINT LOUIS
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State | MO
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Zip | 63126-1697
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Country | US
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Telephone | 314-729-4743
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Fax |
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Provider Business Mailing Address
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Address Line | 1 DETJEN DR
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City | SAINT LOUIS
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State | MO
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Zip | 63126-1697
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Country | US
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Telephone | 314-729-4743
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Fax |
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Authorized Official
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Title or Position | DEPUTY CHIEF / CMO
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Name | MR. LARRY OSTERTAG
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Credential |
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Telephone | 131-472-9474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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