1639230790 NPI number — KIOWA COUNTY DISTRICT THREE EMERGENCY AMBULANCE ASSOCIATION

Table of content: (NPI 1639230790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639230790 NPI number — KIOWA COUNTY DISTRICT THREE EMERGENCY AMBULANCE ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIOWA COUNTY DISTRICT THREE EMERGENCY AMBULANCE ASSOCIATION
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:
6
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:
1639230790
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 220
Provider Second Line Business Mailing Address:
206 SPRUCE STREET
Provider Business Mailing Address City Name:
MOUNTAIN PARK
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73559-0220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-569-2908
Provider Business Mailing Address Fax Number:
580-569-2908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 SPRUCE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN PARK
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73559-0220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-569-2908
Provider Business Practice Location Address Fax Number:
580-569-2908
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCPHAIL
Authorized Official First Name:
DALLAS
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
580-569-2778

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  052 , 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: 590002665 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 892540001-001 . This is a "BC/BS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100818890A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 892540001-001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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