1396846523 NPI number — CIMARRON COUNTY AMBULANCE

Table of content: GABRIEL COSIO PINERO RBT (NPI 1376376988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396846523 NPI number — CIMARRON COUNTY AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CIMARRON COUNTY AMBULANCE
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:
1396846523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73933-0367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-538-8278
Provider Business Mailing Address Fax Number:
580-628-2273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 NE SQUARE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-538-8278
Provider Business Practice Location Address Fax Number:
580-628-2273
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OVERBAY
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
580-544-3021

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  EMS001 , 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: 100820100A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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