=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417073834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MURRAY COUNTY E.M.S.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 08/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1432 W BROADWAY AVE
-----------------------------------------------------
City | SULPHUR
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73086-4216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-622-6630
-----------------------------------------------------
Fax | 580-622-6964
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 545
-----------------------------------------------------
City | SULPHUR
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73086-0545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-622-6630
-----------------------------------------------------
Fax | 580-622-6964
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. BRAD WADE LAMCASTER
-----------------------------------------------------
Credential | PARAMEDIC
-----------------------------------------------------
Telephone | 580-622-6630
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 332
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------