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General NPI Number Information
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NPI Number | 1457585069
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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 | 05/11/2009
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Last Update Date | 05/11/2009
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Provider Practice Location Address
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Address Line | 611 N MAIN
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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 | 580-799-2173
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Fax | 580-995-3628
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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 | 580-799-2173
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Fax | 580-995-3628
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Authorized Official
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Title or Position | EMS DIRECTOR
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Name | MR. ERIC S PEOPLES
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Credential | EMT-B
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Telephone | 580-799-2173
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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 | 411
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License Number State | OK
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