Healthcare Provider Details

I. General information

NPI: 1235280090
Provider Name (Legal Business Name): CITY OF HOOKER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S BROADWAY
HOOKER OK
73945
US

IV. Provider business mailing address

111 S BROADWAY
HOOKER OK
73945
US

V. Phone/Fax

Practice location:
  • Phone: 580-652-2885
  • Fax:
Mailing address:
  • Phone: 580-652-2885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License NumberEMS5050
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberEMS5050
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100819810A
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer

VIII. Authorized Official

Name: MS. LINDA TALBERT
Title or Position: CITY CLERK
Credential:
Phone: 580-652-2885