Provider Demographics
NPI:1073664801
Name:ALFALFA COUNTY EMS, INC
Entity Type:Organization
Organization Name:ALFALFA COUNTY EMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:UNRUH
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:580-541-3672
Mailing Address - Street 1:123 WEST 3RD ST
Mailing Address - Street 2:PO BOX 36
Mailing Address - City:HELENA
Mailing Address - State:OK
Mailing Address - Zip Code:73741-0124
Mailing Address - Country:US
Mailing Address - Phone:580-852-3258
Mailing Address - Fax:580-852-3267
Practice Address - Street 1:123 WEST 3RD ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:OK
Practice Address - Zip Code:73741-0124
Practice Address - Country:US
Practice Address - Phone:580-852-3258
Practice Address - Fax:580-852-3267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS2393416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1009050AMedicaid
OK1009050AMedicaid
OK=========Medicare PIN