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BLACK JACK FIRE PROTECTION DISTRICT
NPI 1043091176
Ambulance - Land Transport in Florissant, MO

Active since October 13, 2023CLIA 26D2082543 · Waiver
5675 N HIGHWAY 67, FLORISSANT, MO 63034(314) 741-9905 Get Directions Write a Review

NPPES record last updated: November 29, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Black Jack Fire Protection District NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLACK JACK FIRE PROTECTION DISTRICT (NPI 1043091176) is a healthcare organization registered as a land transport in Florissant, Missouri and active in the NPI registry since October 2023. The organization holds a CLIA Waiver certificate valid through January 19, 2028 and lists Andrew M Kerckhoff, Deputy Chief Medical Officer, as its authorized official.

NPPES Registry Identity

NPI1043091176
Entity TypeOrganization
Primary Taxonomy3416L0300X
Legal Business NameBLACK JACK FIRE PROTECTION DIST
Location Address5675 N HIGHWAY 67Florissant, MO 63034-2603
Mailing Address5675 N Highway 67Florissant, MO 63034-2603 · (314) 741-9905
Phone(314) 741-9905
Organization SubpartNo
Authorized OfficialAndrew M KerckhoffDeputy Chief Medical Officer · (314) 741-9905
Enumeration DateOctober 13, 2023
Last NPPES UpdateNovember 29, 2023
NPPES CertifiedNovember 29, 2023
✔ NPI 1043091176 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAmbulance · Land TransportTransportation Services
Taxonomy Code3416L0300X
5675 N HIGHWAY 67, Florissant, MO 63034
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Other Names 1

Doing Business AsBlack Jack Fire Protection District

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D2082543

Black Jack Fire Protection District · Florissant, MO
Active · expires Jan 19, 2028
CLIA Number26D2082543
Laboratory TypeFire Protection Dist
Certificate Effective DateJanuary 20, 2026
Certificate Expiration DateJanuary 19, 2028
Laboratory DirectorAndrew Kerckhoff
Laboratory Phone(314) 741-9905
Laboratory LocationBlack Jack Fire Protection District5675 North Highway 67, Florissant, MO 63034
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Ground mileage, per statute mile A0425
Ground mileage per statute mile is a method of calculating the cost of transportation for medical services. It is used when a patient needs to be transported by ground ambulance. The cost is calculated per mile, from the pick-up location to the medical facility.
2,607 services287 patients
Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency) A0427
Ambulance Service, Advanced Life Support, Level 1 (ALS 1 - Emergency) is a critical care transport service for emergency situations. It includes a team of healthcare professionals equipped with advanced skills and tools to manage life-threatening conditions during transport.
248 services196 patients
Ambulance service, basic life support, emergency transport (bls-emergency) A0429
Ambulance service with basic life support (BLS-Emergency) provides immediate transport for patients in critical situations. Medical professionals on board deliver essential care like CPR, wound dressing, and oxygen therapy to stabilize patients during the journey.
187 services119 patients

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Black Jack Fire Protection Dist's NPI number?

The NPI number for Black Jack Fire Protection Dist is 1043091176. It was assigned to this organization in the NPPES registry on October 13, 2023. The provider is doing business as Black Jack Fire Protection District.

Where is Black Jack Fire Protection Dist located?

Black Jack Fire Protection Dist is located at 5675 N Highway 67, Florissant, MO 63034. The listed phone number is (314) 741-9905.

What is Black Jack Fire Protection Dist's specialty?

The primary specialty registered for this NPI is Ambulance, specializing in Land Transport, with taxonomy code 3416L0300X.

Does Black Jack Fire Protection Dist hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D2082543) is associated with this NPI, valid through January 19, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Black Jack Fire Protection Dist was last updated on November 29, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.