Provider Demographics
NPI:1225307283
Name:GREER COUNTY SPECIAL AMBULANCE SERVICE DISTRICT
Entity Type:Organization
Organization Name:GREER COUNTY SPECIAL AMBULANCE SERVICE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-782-5314
Mailing Address - Street 1:121 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-4242
Mailing Address - Country:US
Mailing Address - Phone:580-782-5314
Mailing Address - Fax:580-782-2648
Practice Address - Street 1:121 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-4242
Practice Address - Country:US
Practice Address - Phone:580-782-5314
Practice Address - Fax:580-782-2648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK107341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100820120AMedicaid
OK736006371Medicare UPIN