=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043206444
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SKIATOOK FIRE DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 N A ST
-----------------------------------------------------
City | SKIATOOK
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74070-1100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-396-3422
-----------------------------------------------------
Fax | 918-396-3002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 399
-----------------------------------------------------
City | SKIATOOK
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74070-0399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-396-3422
-----------------------------------------------------
Fax | 918-396-3002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMS MANAGER
-----------------------------------------------------
Name | MR. ANDY D HUDSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-396-3422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | EMS024
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------