1740405117 NPI number — TOWN OF COLBERT

Table of content: (NPI 1740405117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740405117 NPI number — TOWN OF COLBERT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF COLBERT
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:
COLBERT EMS
Provider Other Organization Name Type Code:
5
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:
1740405117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 646021
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75264-6021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-296-2000
Provider Business Mailing Address Fax Number:
580-296-2100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 MOORE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLBERT
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-296-2000
Provider Business Practice Location Address Fax Number:
580-296-2100
Provider Enumeration Date:
04/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COATES
Authorized Official First Name:
TONI
Authorized Official Middle Name:
KAYE
Authorized Official Title or Position:
PARAMEDIC/EMS DIRECTOR
Authorized Official Telephone Number:
580-889-1529

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  125 , 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: 100818390A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".