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General NPI Number Information
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NPI Number | 1366499121
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Entity Type | Organization
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Legal Business Name | MUSKOGEE COUNTY EMERGENCY MEDICAL SERVICE
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 05/09/2022
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Provider Practice Location Address
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Address Line | 200 CALLAHAN ST
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City | MUSKOGEE
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State | OK
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Zip | 74403-5126
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Country | US
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Telephone | 918-683-0130
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Fax | 918-683-9351
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Provider Business Mailing Address
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Address Line | 200 CALLAHAN ST
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City | MUSKOGEE
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State | OK
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Zip | 74403-5126
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Country | US
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Telephone | 918-683-0130
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Fax | 918-683-9351
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. LAUREL HAVENS
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Credential | EMT-P
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Telephone | 918-683-0130
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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 | EMS078
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License Number State | OK
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