Provider Demographics
NPI:1174696702
Name:CITY OF CLAYTON ATTN FINANCE DEPARTMENT
Entity type:Organization
Organization Name:CITY OF CLAYTON ATTN FINANCE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:G
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:THORP
Authorized Official - Suffix:
Authorized Official - Credentials:RN, EMTP
Authorized Official - Phone:314-290-8486
Mailing Address - Street 1:10 N BEMISTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3304
Mailing Address - Country:US
Mailing Address - Phone:314-290-8485
Mailing Address - Fax:314-721-9567
Practice Address - Street 1:10 N BEMISTON AVE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3304
Practice Address - Country:US
Practice Address - Phone:314-290-8485
Practice Address - Fax:314-721-9567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO071064341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO590007477OtherRAILROAD MEDICARE
MO29789OtherBLUE CROSS BLUE SHIELD
MO803286301Medicaid
MO803286301Medicaid