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General NPI Number Information
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NPI Number | 1891735866
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Entity Type | Organization
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Legal Business Name | SOUTHERN OKLAHOMA AMBULANCE SERVICE, INC.
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 517 GRAND AVE
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City | ARDMORE
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State | OK
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Zip | 73401-4338
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Country | US
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Telephone | 580-223-1226
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Fax | 580-226-7154
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Provider Business Mailing Address
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Address Line | 517 GRAND AVE
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City | ARDMORE
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State | OK
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Zip | 73401-4338
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Country | US
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Telephone | 580-223-1226
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Fax | 580-226-7154
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. BOB W. HARGIS
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Credential | CCEMT-P
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Telephone | 580-223-1226
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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 | EMS064
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License Number State | OK
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