1093791865 NPI number — CITY OF CYRIL

Table of content: (NPI 1093791865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093791865 NPI number — CITY OF CYRIL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CYRIL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CYRIL AMBULANCE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093791865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 448
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CYRIL
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73029-0448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-464-2206
Provider Business Mailing Address Fax Number:
580-464-2205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 W. MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CYRIL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-464-2206
Provider Business Practice Location Address Fax Number:
580-464-2205
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANGER
Authorized Official Telephone Number:
405-735-6342

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100819720A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com