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General NPI Number Information
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NPI Number | 1134122591
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Entity Type | Organization
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Legal Business Name | VICI - CAMARGO EMS
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 619 MAIN ST
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City | VICI
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State | OK
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Zip | 73859
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Country | US
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Telephone | 580-995-3350
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 239
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City | VICI
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State | OK
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Zip | 73859-0239
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Country | US
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Telephone | 580-995-3350
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | COLETTA GOODMAN
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Credential |
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Telephone | 580-995-3350
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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 | EMS017
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License Number State | OK
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