Provider Demographics
NPI:1871577411
Name:WEST OVERLAND FIRE PROTECTION DIST OF ST LOUIS COUNTY
Entity type:Organization
Organization Name:WEST OVERLAND FIRE PROTECTION DIST OF ST LOUIS COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-428-6069
Mailing Address - Street 1:PO BOX 501157
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10789 MIDLAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-1839
Practice Address - Country:US
Practice Address - Phone:314-428-6069
Practice Address - Fax:314-428-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1891893416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
33608OtherGHP PROVIDER NO.
8181099OtherUNITED HEALTHCARE PROV #
590012870OtherRAILROAD MEDICARE PROV #
119728OtherBCBS PROVIDER NO.
9019OtherHEALTHCAREUSA PROVIDER NO
MO801179805Medicaid
MO801179805Medicaid