Healthcare Provider Details

I. General information

NPI: 1154458149
Provider Name (Legal Business Name): TOWN OF VELMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 MAIN STREET
VELMA OK
73491
US

IV. Provider business mailing address

PO BOX 447 TOWN OF VELMA
VELMA OK
73491
US

V. Phone/Fax

Practice location:
  • Phone: 580-444-2535
  • Fax: 580-444-2522
Mailing address:
  • Phone: 580-444-2535
  • Fax: 580-444-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberEMS302
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberEMS302
License Number StateOK

VIII. Authorized Official

Name: MRS. JIL RAE ROBERTS
Title or Position: VELMA TOWN CLERK
Credential:
Phone: 580-444-3393