MEDICARE: ATOKA COUNTY AMBULANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	EMS028	OK

General Provider Information

NPI Number	:	1598703555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATOKA COUNTY AMBULANCE

Provider Business Mailing Address
First Line	:	1384A W LIBERTY RD
Second Line	:
City	:	ATOKA
State	:	OK
Zip	:	74525-1625
Country	:	US
Telephone Number	:	580-364-0777
Fax Number	:	580-364-0037

Provider Business Practice Location Address
First Line	:	1384A W LIBERTY RD
Second Line	:
City	:	ATOKA
State	:	OK
Zip	:	74525
Country	:	US
Telephone Number	:	580-364-0777
Fax Number	:	580-364-0037

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	DONNA EAGLEBERGER
Credential	:	PARAMEDIC
Telephone Number	:	580-364-0777

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	05/30/2018

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Directions to “ATOKA COUNTY AMBULANCE ” Practice Location

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