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General NPI Number Information
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NPI Number | 1972656205
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Entity Type | Organization
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Legal Business Name | CANTON-LONGDALE EMS DISTRICT
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | #2 DEPOT RD
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City | CANTON
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State | OK
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Zip | 73724-0039
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Country | US
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Telephone | 580-886-2515
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 39
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City | CANTON
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State | OK
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Zip | 73724-0039
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Country | US
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Telephone | 580-886-2515
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CONNIE LEA SPRUNGER
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Credential |
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Telephone | 580-886-2515
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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 | EMS111
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License Number State | OK
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