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General NPI Number Information
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NPI Number | 1154432201
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Entity Type | Organization
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Legal Business Name | TILLMAN COUNTY OKLAHOMA EMERGENCY
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 300 E LUCILLE AVE
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City | FREDERICK
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State | OK
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Zip | 73542-1422
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Country | US
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Telephone | 580-335-5877
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Fax | 580-335-5512
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Provider Business Mailing Address
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Address Line | 300 E LUCILLE AVE
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City | FREDERICK
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State | OK
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Zip | 73542-1422
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Country | US
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Telephone | 580-335-5877
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Fax | 580-335-5512
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JACKIE L JOHNSON
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Credential |
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Telephone | 580-335-5877
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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 | EMS115
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License Number State | OK
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