Provider Demographics
NPI:1922483585
Name:CITY OF PERRY FIRE DEPARTMENT
Entity Type:Organization
Organization Name:CITY OF PERRY FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-336-9755
Mailing Address - Street 1:732 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-6425
Mailing Address - Country:US
Mailing Address - Phone:580-336-9755
Mailing Address - Fax:
Practice Address - Street 1:732 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-6425
Practice Address - Country:US
Practice Address - Phone:580-336-9755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK059251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare