Provider Demographics
NPI:1497747901
Name:CREEK COUNTY EMERGENCY AMBULANCE SERVICE DISTRICT
Entity Type:Organization
Organization Name:CREEK COUNTY EMERGENCY AMBULANCE SERVICE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-227-4111
Mailing Address - Street 1:123 E HOBSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-2807
Mailing Address - Country:US
Mailing Address - Phone:918-227-4111
Mailing Address - Fax:918-227-4395
Practice Address - Street 1:123 E HOBSON AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-2807
Practice Address - Country:US
Practice Address - Phone:918-227-4111
Practice Address - Fax:918-227-4395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100818820Medicaid
=========Medicare ID - Type Unspecified