Provider Demographics
NPI:1376641837
Name:ALFALFA COUNTY EMS
Entity Type:Organization
Organization Name:ALFALFA COUNTY EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HALCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:580-596-3326
Mailing Address - Street 1:121 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:OK
Mailing Address - Zip Code:73728-1515
Mailing Address - Country:US
Mailing Address - Phone:580-596-3326
Mailing Address - Fax:580-628-2267
Practice Address - Street 1:121 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:OK
Practice Address - Zip Code:73728-1515
Practice Address - Country:US
Practice Address - Phone:580-596-3326
Practice Address - Fax:580-628-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK000163416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK00016OtherSTATE LICENSE NUMBER
OK100819680AMedicaid
OK100819680AMedicaid
OK00016OtherSTATE LICENSE NUMBER
OK=========Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER