Healthcare Provider Details

I. General information

NPI: 1700962149
Provider Name (Legal Business Name): OTIS EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAURA & MAIN ST
OTIS KS
67565
US

IV. Provider business mailing address

PO BOX 155
OTIS KS
67565-0155
US

V. Phone/Fax

Practice location:
  • Phone: 785-387-2296
  • Fax:
Mailing address:
  • Phone: 785-387-2296
  • Fax: 785-387-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1480
License Number StateKS

VIII. Authorized Official

Name: EVERETT ROYER
Title or Position: BILLING DIRECTOR
Credential: EMT-I
Phone: 785-387-2296