Provider Demographics
NPI:1316012032
Name:CHOCTAW COUNTY EMERGENCY MEDICAL SERVICES INC.
Entity Type:Organization
Organization Name:CHOCTAW COUNTY EMERGENCY MEDICAL SERVICES INC.
Other - Org Name:CHOCTAW AMBULANCE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:205-459-5512
Mailing Address - Street 1:816 W PUSHMATAHA ST
Mailing Address - Street 2:P.O. BOX 287
Mailing Address - City:BUTLER
Mailing Address - State:AL
Mailing Address - Zip Code:36904-2440
Mailing Address - Country:US
Mailing Address - Phone:205-459-5512
Mailing Address - Fax:205-459-5513
Practice Address - Street 1:816 W PUSHMATAHA ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:AL
Practice Address - Zip Code:36904-2440
Practice Address - Country:US
Practice Address - Phone:205-459-5512
Practice Address - Fax:205-459-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1613416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000050101Medicare ID - Type UnspecifiedAMBULANCE