Healthcare Provider Details

I. General information

NPI: 1598703555
Provider Name (Legal Business Name): ATOKA COUNTY AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1384A W LIBERTY RD
ATOKA OK
74525
US

IV. Provider business mailing address

1384A W LIBERTY RD
ATOKA OK
74525-1625
US

V. Phone/Fax

Practice location:
  • Phone: 580-364-0777
  • Fax: 580-364-0037
Mailing address:
  • Phone: 580-364-0777
  • Fax: 580-364-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEMS028
License Number StateOK

VIII. Authorized Official

Name: DONNA EAGLEBERGER
Title or Position: EMS DIRECTOR
Credential: PARAMEDIC
Phone: 580-364-0777