Provider Demographics
NPI:1336260918
Name:CITY OF BROKEN ARROW
Entity Type:Organization
Organization Name:CITY OF BROKEN ARROW
Other - Org Name:BROKEN ARROW FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:SEMENTELLI
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-259-2400
Mailing Address - Street 1:EMS SERVICES DEPT 1211
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74182-0001
Mailing Address - Country:US
Mailing Address - Phone:918-259-2400
Mailing Address - Fax:918-259-8219
Practice Address - Street 1:220 S 1ST ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4152
Practice Address - Country:US
Practice Address - Phone:918-259-2531
Practice Address - Fax:918-259-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS0233416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100819630AMedicaid
OK1336260918OtherBC BS OF OK
OK2642Medicare PIN
OK1336260918OtherBC BS OF OK