Provider Demographics
NPI:1043419286
Name:CITY OF HARTSHORNE
Entity Type:Organization
Organization Name:CITY OF HARTSHORNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY CLERK
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-297-2544
Mailing Address - Street 1:1101 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSHORNE
Mailing Address - State:OK
Mailing Address - Zip Code:74547-3833
Mailing Address - Country:US
Mailing Address - Phone:918-297-2544
Mailing Address - Fax:918-297-2594
Practice Address - Street 1:1101 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HARTSHORNE
Practice Address - State:OK
Practice Address - Zip Code:74547-3833
Practice Address - Country:US
Practice Address - Phone:918-297-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS0473416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100820210AMedicaid