Black Jack Fire Protection Dist

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

BLACK JACK FIRE PROTECTION DIST

Practice address

5675 N Highway 67
Florissant, MO 63034-2603

Phone

(314) 741-9905

NPI assigned

Oct 13, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andrew M Kerckhoff, PARAMEDIC

Title

Deputy Chief Medical Officer

Phone

(314) 741-9905

Specialties & licenses 1

Addresses

Other names 1

• Black Jack Fire Protection District Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701216000000",
    "number": "1043091176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5675 N HIGHWAY 67",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630342603",
            "telephone_number": "314-741-9905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5675 N HIGHWAY 67",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630342603",
            "telephone_number": "314-741-9905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK JACK FIRE PROTECTION DIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-13",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A",
        "authorized_official_last_name": "KERCKHOFF",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DEPUTY CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "314-741-9905",
        "authorized_official_credential": "PARAMEDIC"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Black Jack Fire Protection District",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Black Jack Fire Protection District",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bio-Medical Applications of Missouri, Inc.
• Bio-Medical Applications of Missouri, Inc.
• BJC Behavioral Health
• BK Podiatry Centers, LLC
• BK Podiatry Centers, LLC
• Danielle Blackwell
• Helen Elizabeth Blair, BSN, RN
• Ayendi Blanchard
• Mary Blaylock
• Yolanda Bledsoe, MD

• Land Ambulance in Florissant, MO
• Providers in Florissant, MO by specialty
• Land Ambulance in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.