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General NPI Number Information
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NPI Number | 1033112776
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Entity Type | Organization
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Legal Business Name | LEEDEY AMBULANCE SERVICE
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Dates
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Enumeration Date | 05/26/2005
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | 401 S MAIN
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City | LEEDEY
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State | OK
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Zip | 73654
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Country | US
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Telephone | 580-488-3812
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Fax | 580-488-2191
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | LEEDEY
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State | OK
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Zip | 73654-0190
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Country | US
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Telephone | 580-488-3812
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Fax | 580-488-2191
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Authorized Official
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Title or Position | DIRECTOR
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Name | KENNETH WOHL
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Credential |
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Telephone | 580-488-2101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | EMS113
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License Number State | OK
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