Provider Demographics
NPI:1114044658
Name:TOWN OF WELLSTON
Entity Type:Organization
Organization Name:TOWN OF WELLSTON
Other - Org Name:WELLSTON EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANESA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-382-6246
Mailing Address - Street 1:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OK
Mailing Address - Zip Code:74881-0353
Mailing Address - Country:US
Mailing Address - Phone:405-356-2476
Mailing Address - Fax:
Practice Address - Street 1:211 CEDAR ST.
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OK
Practice Address - Zip Code:74881
Practice Address - Country:US
Practice Address - Phone:405-356-2476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS1683416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========001OtherFEDERAL BLUE CROSS
OK=========001OtherOKLAHOMA BLUE CROSS
OK=========001OtherFEDERAL BLUE CROSS
OK=========001OtherOKLAHOMA BLUE CROSS