MEDICARE: JACKSON COUNTY EMERGENCY MEDICAL SERVICE DISTRICT

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	EMS238	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598768335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON COUNTY EMERGENCY MEDICAL SERVICE DISTRICT

Provider Business Mailing Address
First Line	:	1309 N PARK LN
Second Line	:
City	:	ALTUS
State	:	OK
Zip	:	73521-4552
Country	:	US
Telephone Number	:	580-477-4112
Fax Number	:	580-477-1070

Provider Business Practice Location Address
First Line	:	1309 N PARK LN
Second Line	:
City	:	ALTUS
State	:	OK
Zip	:	73521-4552
Country	:	US
Telephone Number	:	580-477-4112
Fax Number	:	580-477-1070

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. TAMMIE B SAVILLE
Credential	:
Telephone Number	:	580-477-4112

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/03/2009

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