Provider Demographics
NPI:1154458149
Name:TOWN OF VELMA
Entity Type:Organization
Organization Name:TOWN OF VELMA
Other - Org Name:DBA: VELMA COMMUNITY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VELMA TOWN CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:JIL
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-444-3393
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:TOWN OF VELMA
Mailing Address - City:VELMA
Mailing Address - State:OK
Mailing Address - Zip Code:73491
Mailing Address - Country:US
Mailing Address - Phone:580-444-2535
Mailing Address - Fax:580-444-2522
Practice Address - Street 1:910 MAIN STREET
Practice Address - Street 2:
Practice Address - City:VELMA
Practice Address - State:OK
Practice Address - Zip Code:73491
Practice Address - Country:US
Practice Address - Phone:580-444-2535
Practice Address - Fax:580-444-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS302146N00000X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
No341600000XTransportation ServicesAmbulanceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100818290AMedicaid
OK=========001OtherBCBS
OK100818290AMedicaid
OK=========001OtherBLUE CROSS BLUE SHIELD
OK=========Medicare ID - Type Unspecified