Provider Demographics
NPI:1093736746
Name:MAYES EMERGENCY SERVICES TRUST AUTHORITY
Entity Type:Organization
Organization Name:MAYES EMERGENCY SERVICES TRUST AUTHORITY
Other - Org Name:MESTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-825-6825
Mailing Address - Street 1:4 REDDEN
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-8800
Mailing Address - Country:US
Mailing Address - Phone:918-825-6825
Mailing Address - Fax:918-825-6234
Practice Address - Street 1:4 REDDEN
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-8800
Practice Address - Country:US
Practice Address - Phone:918-825-6825
Practice Address - Fax:918-825-6234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2653416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100819190AMedicaid
OK=========OtherBC/BS
OK=========OtherBC/BS