Healthcare Provider Details

I. General information

NPI: 1891798450
Provider Name (Legal Business Name): CITY OF POND CREEK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S 2ND
POND CREEK OK
73766
US

IV. Provider business mailing address

PO BOX 6
POND CREEK OK
73766-0006
US

V. Phone/Fax

Practice location:
  • Phone: 580-532-4915
  • Fax: 580-532-4913
Mailing address:
  • Phone: 580-532-4915
  • Fax: 580-532-4913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberEMS061
License Number StateOK

VIII. Authorized Official

Name: MR. HOWARD HALCOMB
Title or Position: DIRECTOR
Credential:
Phone: 580-532-4911