=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366446254
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF CHICKASHA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 N 6TH ST
-----------------------------------------------------
City | CHICKASHA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73018-2407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-222-6033
-----------------------------------------------------
Fax | 405-222-6034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 N 6TH ST
-----------------------------------------------------
City | CHICKASHA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73018-2407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-222-6033
-----------------------------------------------------
Fax | 405-222-6034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | MR. RONNIE KESSLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-222-6035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | EMS007
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------