MEDICARE: AFFTON FIRE PROTECTION DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	189413	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	17919	OTHER	HEALTHCAREUSA PROV. NO.
2	8182116	OTHER	UNITED HEALTHCARE PROV. #
3	122372	OTHER	BCBS PROVIDER NO.
4	33911	OTHER	GHP PROVIDER NO.
5	412155	OTHER	HEALTHLINK PROVIDER NO.

General Provider Information

NPI Number	:	1235110792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFTON FIRE PROTECTION DISTRICT

Provider Business Mailing Address
First Line	:	2840 RELIABLE PARKWAY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60686-0001
Country	:	US
Telephone Number	:	314-631-1803
Fax Number	:

Provider Business Practice Location Address
First Line	:	9282 GRAVOIS RD
Second Line	:
City	:	AFFTON
State	:	MO
Zip	:	63123-4526
Country	:	US
Telephone Number	:	314-631-1803
Fax Number	:	314-353-7679

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	JOHN F RAUSCH
Credential	:
Telephone Number	:	314-631-1803

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	04/16/2008

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Directions to “AFFTON FIRE PROTECTION DISTRICT ” Practice Location

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