Healthcare Provider Details

I. General information

NPI: 1003997628
Provider Name (Legal Business Name): HOMINY COMMUNITY MEDICAL TRUST AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N. EASTERN
HOMINY OK
74035-1034
US

IV. Provider business mailing address

PO BOX 98
HOMINY OK
74035-0098
US

V. Phone/Fax

Practice location:
  • Phone: 800-538-8278
  • Fax: 580-628-2273
Mailing address:
  • Phone: 800-538-8278
  • Fax: 580-628-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEMS421
License Number StateOK

VIII. Authorized Official

Name: BRETT WHITTEN
Title or Position: EMS DIRECTOR
Credential:
Phone: 800-538-8278