Provider Demographics
NPI:1366499121
Name:MUSKOGEE COUNTY EMERGENCY MEDICAL SERVICE
Entity Type:Organization
Organization Name:MUSKOGEE COUNTY EMERGENCY MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:918-683-0130
Mailing Address - Street 1:200 CALLAHAN ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-5126
Mailing Address - Country:US
Mailing Address - Phone:918-683-0130
Mailing Address - Fax:918-683-9351
Practice Address - Street 1:200 CALLAHAN ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-5126
Practice Address - Country:US
Practice Address - Phone:918-683-0130
Practice Address - Fax:918-683-9351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS0783416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK590001059OtherRAILROAD MEDICARE
OK100820180AMedicaid
OK736006395Medicare PIN