Provider Demographics
NPI:1487657177
Name:CITY OF MARSHALL
Entity Type:Organization
Organization Name:CITY OF MARSHALL
Other - Org Name:MARSHALL VOLUNTEER AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-935-6770
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:OK
Mailing Address - Zip Code:73056-0277
Mailing Address - Country:US
Mailing Address - Phone:580-935-6785
Mailing Address - Fax:405-969-2485
Practice Address - Street 1:112 E MAIN
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:OK
Practice Address - Zip Code:73056
Practice Address - Country:US
Practice Address - Phone:580-935-6785
Practice Address - Fax:405-969-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS1773416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========-002OtherBCBS PROVIDER #
OK=========Medicare ID - Type Unspecified