Provider Demographics
NPI:1437603768
Name:CITY OF WATONGA
Entity Type:Organization
Organization Name:CITY OF WATONGA
Other - Org Name:WATONGA EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-919-1203
Mailing Address - Street 1:305 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772
Mailing Address - Country:US
Mailing Address - Phone:580-919-1203
Mailing Address - Fax:
Practice Address - Street 1:305 W MAIN
Practice Address - Street 2:
Practice Address - City:WATONGA
Practice Address - State:OK
Practice Address - Zip Code:73772
Practice Address - Country:US
Practice Address - Phone:580-623-5885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS-5013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport