Provider Demographics
NPI:1396846523
Name:CIMARRON COUNTY AMBULANCE
Entity Type:Organization
Organization Name:CIMARRON COUNTY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:OVERBAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-544-3021
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:BOISE CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73933-0367
Mailing Address - Country:US
Mailing Address - Phone:800-538-8278
Mailing Address - Fax:580-628-2273
Practice Address - Street 1:18 NE SQUARE
Practice Address - Street 2:
Practice Address - City:BOISE CITY
Practice Address - State:OK
Practice Address - Zip Code:73933
Practice Address - Country:US
Practice Address - Phone:800-538-8278
Practice Address - Fax:580-628-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS0013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100820100AMedicaid
OK=========-001OtherBCBS PROVIDER NUMBER
OK736006353Medicare PIN