Healthcare Provider Details

I. General information

NPI: 1023075736
Provider Name (Legal Business Name): GREER COUNTY SPECIAL AMBULANCE SERVICE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E JEFFERSON ST
MANGUM OK
73554-4242
US

IV. Provider business mailing address

121 E JEFFERSON ST
MANGUM OK
73554-4242
US

V. Phone/Fax

Practice location:
  • Phone: 580-782-5314
  • Fax: 580-782-2648
Mailing address:
  • Phone: 580-782-5314
  • Fax: 580-782-2648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number107EMS
License Number StateOK

VIII. Authorized Official

Name: MR. MICHAEL SCOTT AUGUSTINE
Title or Position: ADMINISTRATOR
Credential:
Phone: 580-782-5314