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General NPI Number Information
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NPI Number | 1639230790
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Entity Type | Organization
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Legal Business Name | KIOWA COUNTY DISTRICT THREE EMERGENCY AMBULANCE ASSOCIATION
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 01/27/2009
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Provider Practice Location Address
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Address Line | 206 SPRUCE STREET
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City | MOUNTAIN PARK
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State | OK
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Zip | 73559-0220
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Country | US
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Telephone | 580-569-2908
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Fax | 580-569-2908
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Provider Business Mailing Address
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Address Line | PO BOX 220 206 SPRUCE STREET
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City | MOUNTAIN PARK
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State | OK
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Zip | 73559-0220
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Country | US
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Telephone | 580-569-2908
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Fax | 580-569-2908
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. DALLAS RAY MCPHAIL
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Credential |
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Telephone | 580-569-2778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 052
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License Number State | OK
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