Healthcare Provider Details

I. General information

NPI: 1760481394
Provider Name (Legal Business Name): JOHNSTON COUNTY EMERGENCY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 E 24TH ST
TISHOMINGO OK
73460-3245
US

IV. Provider business mailing address

604 E 24TH ST
TISHOMINGO OK
73460-3245
US

V. Phone/Fax

Practice location:
  • Phone: 580-371-0569
  • Fax: 580-371-0570
Mailing address:
  • Phone: 580-371-0569
  • Fax: 580-371-0570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number079
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateOK

VIII. Authorized Official

Name: MR. KENNETH W POWER
Title or Position: DIRECTOR
Credential:
Phone: 580-371-0569