Healthcare Provider Details

I. General information

NPI: 1881859718
Provider Name (Legal Business Name): GRANDFIELD AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W 3RD ST
GRANDFIELD OK
73546-9238
US

IV. Provider business mailing address

103 W 3RD ST PO BOX 655
GRANDFIELD OK
73546-9238
US

V. Phone/Fax

Practice location:
  • Phone: 580-479-5589
  • Fax: 580-479-5589
Mailing address:
  • Phone: 580-479-5589
  • Fax: 580-479-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number030
License Number StateOK

VIII. Authorized Official

Name: MRS. CATHY GROUNDS
Title or Position: DIRECTOR
Credential: EMT
Phone: 580-479-5589