Provider Demographics
NPI:1508922295
Name:MEDICUS
Entity Type:Organization
Organization Name:MEDICUS
Other - Org Name:SEMINOLE FIRE - RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYANT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-382-2454
Mailing Address - Street 1:900 N. HARVEY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868
Mailing Address - Country:US
Mailing Address - Phone:405-382-1314
Mailing Address - Fax:405-303-2328
Practice Address - Street 1:900 N. HARVEY
Practice Address - Street 2:SUITE A
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868
Practice Address - Country:US
Practice Address - Phone:405-382-1314
Practice Address - Fax:405-303-2328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS1263416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100820000AMedicaid
OK100820000AMedicaid
OK736005421Medicare ID - Type Unspecified
OK100820000AMedicaid