MEDICARE: CITY OF WAYNOKA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	EMS004	OK

General Provider Information

NPI Number	:	1043213002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF WAYNOKA

Provider Business Mailing Address
First Line	:	201 E CECIL ST
Second Line	:
City	:	WAYNOKA
State	:	OK
Zip	:	73860-1233
Country	:	US
Telephone Number	:	580-824-2261
Fax Number	:	580-824-3000

Provider Business Practice Location Address
First Line	:	201 E CECIL ST
Second Line	:
City	:	WAYNOKA
State	:	OK
Zip	:	73860-1233
Country	:	US
Telephone Number	:	580-824-2261
Fax Number	:	580-824-3000

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SCOTT SMILEY
Credential	:
Telephone Number	:	580-824-2261

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/22/2020

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Directions to “CITY OF WAYNOKA ” Practice Location

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