Provider Demographics
NPI:1336294099
Name:CITY OF PICHER
Entity Type:Organization
Organization Name:CITY OF PICHER
Other - Org Name:PICHER FIRE & EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-673-1709
Mailing Address - Street 1:101 N CONNELL AVE
Mailing Address - Street 2:
Mailing Address - City:PICHER
Mailing Address - State:OK
Mailing Address - Zip Code:74360-1505
Mailing Address - Country:US
Mailing Address - Phone:918-673-1709
Mailing Address - Fax:918-673-2724
Practice Address - Street 1:213 CARL PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:PICHER
Practice Address - State:OK
Practice Address - Zip Code:74360-1609
Practice Address - Country:US
Practice Address - Phone:918-673-1709
Practice Address - Fax:918-673-2724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100819930AMedicaid
OK300522236OtherBLUE CROSS BLUE SHIELD
OK300522236OtherBLUE CROSS BLUE SHIELD