Provider Demographics
NPI:1588345433
Name:CITY OF CRESTWOOD
Entity type:Organization
Organization Name:CITY OF CRESTWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF / CMO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTERTAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:131-472-9474
Mailing Address - Street 1:1 DETJEN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1697
Mailing Address - Country:US
Mailing Address - Phone:314-729-4743
Mailing Address - Fax:
Practice Address - Street 1:1 DETJEN DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1697
Practice Address - Country:US
Practice Address - Phone:314-729-4743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport