Provider Demographics
NPI:1689089542
Name:WEST BRYAN COUNTY VOLUNTEER FIRE AND RESUE DEPARTMENT
Entity Type:Organization
Organization Name:WEST BRYAN COUNTY VOLUNTEER FIRE AND RESUE DEPARTMENT
Other - Org Name:WEST BRYAN COUNTY FIRE AND RESCUE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:BRERNTON
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-380-2502
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:OK
Mailing Address - Zip Code:73449-0030
Mailing Address - Country:US
Mailing Address - Phone:580-380-2502
Mailing Address - Fax:
Practice Address - Street 1:3809 WEST US HWY 70
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:OK
Practice Address - Zip Code:73449-0030
Practice Address - Country:US
Practice Address - Phone:580-380-2502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMRA215341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance