Provider Demographics
NPI:1033115522
Name:EMERGENCY MEDICAL SERVICES PLUS, LLC
Entity Type:Organization
Organization Name:EMERGENCY MEDICAL SERVICES PLUS, LLC
Other - Org Name:EMS PLUS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ROYAL
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-770-7895
Mailing Address - Street 1:PO BOX 197
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-0197
Mailing Address - Country:US
Mailing Address - Phone:214-770-7895
Mailing Address - Fax:918-258-6675
Practice Address - Street 1:14522 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033
Practice Address - Country:US
Practice Address - Phone:214-770-7895
Practice Address - Fax:918-258-6675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3583416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100819570AMedicaid
ILPR40186430001OtherCIGNA
OK=========001OtherBLUE CROSS AND BLUE SHIEL
OK900522037Medicare ID - Type UnspecifiedPROVIDER NUMBER
ILPR40186430001OtherCIGNA