Provider Demographics
NPI:1144223199
Name:MAJOR COUNTY EMERGENCY MEDICAL SERVICE
Entity Type:Organization
Organization Name:MAJOR COUNTY EMERGENCY MEDICAL SERVICE
Other - Org Name:MAJOR COUNTY EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ICKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-227-2322
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737-0511
Mailing Address - Country:US
Mailing Address - Phone:580-227-2322
Mailing Address - Fax:580-227-2322
Practice Address - Street 1:224 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737-1623
Practice Address - Country:US
Practice Address - Phone:580-227-2322
Practice Address - Fax:580-227-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS0543416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========-001OtherBCBS PROVIDER #
OK=========-001OtherBCBS PROVIDER #