1376641837 NPI number — ALFALFA COUNTY EMS

Table of content: (NPI 1376641837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376641837 NPI number — ALFALFA COUNTY EMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALFALFA COUNTY EMS
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:
Provider Other Organization Name Type Code:
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:
1376641837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 N GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEROKEE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73728-1515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-596-3326
Provider Business Mailing Address Fax Number:
580-628-2267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 N GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEROKEE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73728-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-596-3326
Provider Business Practice Location Address Fax Number:
580-628-2267
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HALCOMB
Authorized Official First Name:
SARA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
EMT
Authorized Official Telephone Number:
580-596-3326

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  00016 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00016 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100819680A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".