Provider Demographics
NPI:1356874721
Name:CEDAR RAPIDS FIRE DEPARTMENT
Entity type:Organization
Organization Name:CEDAR RAPIDS FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:WISNOUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:319-533-2376
Mailing Address - Street 1:713 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1321
Mailing Address - Country:US
Mailing Address - Phone:319-286-5242
Mailing Address - Fax:
Practice Address - Street 1:713 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1321
Practice Address - Country:US
Practice Address - Phone:319-286-5242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency