Healthcare Provider Details

I. General information

NPI: 1750424750
Provider Name (Legal Business Name): APACHE AMBULANCE SERVICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S COBLAKE ST
APACHE OK
73006-8334
US

IV. Provider business mailing address

PO BOX 200
APACHE OK
73006-0200
US

V. Phone/Fax

Practice location:
  • Phone: 580-588-3305
  • Fax: 580-588-3305
Mailing address:
  • Phone: 580-588-3305
  • Fax: 580-588-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEMS210
License Number StateOK

VIII. Authorized Official

Name: SANDY HADEN
Title or Position: DIRECTOR
Credential:
Phone: 580-588-3305