Healthcare Provider Details

I. General information

NPI: 1346388790
Provider Name (Legal Business Name): CITY OF SKIATOOK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 N A ST
SKIATOOK OK
74070-1100
US

IV. Provider business mailing address

PO BOX 399
SKIATOOK OK
74070-0399
US

V. Phone/Fax

Practice location:
  • Phone: 918-396-3580
  • Fax:
Mailing address:
  • Phone: 918-396-3580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number024
License Number StateOK

VIII. Authorized Official

Name: CHUCK LEWIS WILLIAMSON
Title or Position: EMS DIRECTOR
Credential:
Phone: 918-396-3580