Provider Demographics
NPI:1427127307
Name:OKLAHOMA VOL FIRE DEPT #1
Entity type:Organization
Organization Name:OKLAHOMA VOL FIRE DEPT #1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:FETTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-727-3952
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:130 WASHINGTON RD
Mailing Address - City:APOLLO
Mailing Address - State:PA
Mailing Address - Zip Code:15613-0142
Mailing Address - Country:US
Mailing Address - Phone:724-727-3955
Mailing Address - Fax:724-727-3953
Practice Address - Street 1:311 16TH ST
Practice Address - Street 2:
Practice Address - City:NORTH APOLLO
Practice Address - State:PA
Practice Address - Zip Code:15673-0787
Practice Address - Country:US
Practice Address - Phone:724-727-3955
Practice Address - Fax:724-727-3953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA060513416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
803266OtherBLACK LUNG
05088311OtherAETNA US HEALTHCARE
8122OtherHEALTH AMERICA
PA66979Medicaid
PA0007007420001Medicaid
PA1018626Medicaid
V0V212OtherUPMC
292043OtherHIGHMARK
803266OtherBLACK LUNG
PA66979Medicaid