Provider Demographics
NPI:1699757997
Name:ROBERTSON FIRE PROTECTION DISTRICT
Entity type:Organization
Organization Name:ROBERTSON FIRE PROTECTION DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-291-6671
Mailing Address - Street 1:PO BOX 771242
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63177-2242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12641 MISSOURI BOTTOM RD
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1517
Practice Address - Country:US
Practice Address - Phone:314-291-6180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1893593416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
122576OtherBCBS PROVIDER NO.
12752OtherHEALTHCAREUSA PROV NO.
33653OtherGHP PROVIDER NO.
8181007OtherUNITED HEALTHCARE PROV #
112682OtherHEALTHLINK PROVIDER NO.