Provider Demographics
NPI:1114992096
Name:HAVEN COMMUNITY EMS
Entity Type:Organization
Organization Name:HAVEN COMMUNITY EMS
Other - Org Name:HAVEN COMMUNITY AMBULANCE SERVICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:TROYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-728-4563
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:TONKAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74653-0468
Mailing Address - Country:US
Mailing Address - Phone:620-465-3618
Mailing Address - Fax:580-628-2267
Practice Address - Street 1:120 S KANSAS ST
Practice Address - Street 2:
Practice Address - City:HAVEN
Practice Address - State:KS
Practice Address - Zip Code:67543-9278
Practice Address - Country:US
Practice Address - Phone:620-465-2364
Practice Address - Fax:620-465-2364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS780341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100091720AMedicaid
KS200613870AMedicaid
KS005608Medicare ID - Type Unspecified