Provider Demographics
NPI:1215111257
Name:CITY OF SHIDLER
Entity type:Organization
Organization Name:CITY OF SHIDLER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-793-7171
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:351 N. COSDEN
Mailing Address - City:SHIDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74652-0335
Mailing Address - Country:US
Mailing Address - Phone:918-793-7171
Mailing Address - Fax:
Practice Address - Street 1:351 NORTH COSDEN
Practice Address - Street 2:
Practice Address - City:SHIDLER
Practice Address - State:OK
Practice Address - Zip Code:74652
Practice Address - Country:US
Practice Address - Phone:918-793-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS089341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance