MEDICARE: WALTERS VOLUNTEER 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	EMS198	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699833798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTERS VOLUNTEER AMBULANCE

Provider Business Mailing Address
First Line	:	PO BOX 394
Second Line	:
City	:	WALTERS
State	:	OK
Zip	:	73572-2032
Country	:	US
Telephone Number	:	580-875-2400
Fax Number	:	580-875-3574

Provider Business Practice Location Address
First Line	:	119 S BROADWAY
Second Line	:
City	:	WALTERS
State	:	OK
Zip	:	73572-2032
Country	:	US
Telephone Number	:	580-875-2400
Fax Number	:	580-875-3574

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. EVA VIRGINIA FRYER
Credential	:	RN EMT DIRECTOR
Telephone Number	:	580-875-2400

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	06/05/2008

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