Healthcare Provider Details

I. General information

NPI: 1457457632
Provider Name (Legal Business Name): CENTRAL MED EMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E 6TH ST
PAWHUSKA OK
74056-4205
US

IV. Provider business mailing address

201 E 6TH ST
PAWHUSKA OK
74056-4205
US

V. Phone/Fax

Practice location:
  • Phone: 918-287-1341
  • Fax:
Mailing address:
  • Phone: 918-287-1341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number385
License Number StateOK

VIII. Authorized Official

Name: JENNIFER DIANNE WEAVER
Title or Position: DIRECTOR
Credential:
Phone: 918-287-1341