Healthcare Provider Details

I. General information

NPI: 1326286717
Provider Name (Legal Business Name): TOWN OF CLAYTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W. CHEROKEE STREET
CLAYTON OK
74536
US

IV. Provider business mailing address

PO BOX 279
CLAYTON OK
74536-0279
US

V. Phone/Fax

Practice location:
  • Phone: 918-569-4437
  • Fax:
Mailing address:
  • Phone: 918-569-4437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberEMS439
License Number StateOK

VIII. Authorized Official

Name: JENNIFER SPRUELL
Title or Position: ASSISTANT DIRECTOR
Credential:
Phone: 918-569-4437