1700889839 NPI number — GARBER EMERGENCY MEDICAL SERVICE (GEMS)

Table of content: (NPI 1700889839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700889839 NPI number — GARBER EMERGENCY MEDICAL SERVICE (GEMS)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARBER EMERGENCY MEDICAL SERVICE (GEMS)
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:
GARBER EMS
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:
1700889839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19907 E PHILLIPS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARBER
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73738-0497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-863-2961
Provider Business Mailing Address Fax Number:
580-863-5271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19907 E PHILLIPS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARBER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73738-0497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-863-2961
Provider Business Practice Location Address Fax Number:
580-863-5271
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LONG
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
HAL
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
580-863-2961

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  EMS424 , 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: 100818930A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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