Healthcare Provider Details

I. General information

NPI: 1639198989
Provider Name (Legal Business Name): CITY OF JAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S. 5TH ST
JAY OK
74346
US

IV. Provider business mailing address

P.O. BOX 348
JAY OK
74346-0348
US

V. Phone/Fax

Practice location:
  • Phone: 918-253-6198
  • Fax: 918-253-2286
Mailing address:
  • Phone: 918-253-4148
  • Fax: 918-253-2286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number200
License Number StateOK

VIII. Authorized Official

Name: MR. PATRICK DAKOTA JENNINGS
Title or Position: DIRECTOR OF EMS
Credential: NRP
Phone: 918-253-6198