Provider Demographics
NPI:1508934944
Name:TOWN OF GOODWELL
Entity Type:Organization
Organization Name:TOWN OF GOODWELL
Other - Org Name:GOODWELL AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-349-2566
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:GOODWELL
Mailing Address - State:OK
Mailing Address - Zip Code:73939-0759
Mailing Address - Country:US
Mailing Address - Phone:580-349-2566
Mailing Address - Fax:580-349-2983
Practice Address - Street 1:104 S MAIN
Practice Address - Street 2:
Practice Address - City:GOODWELL
Practice Address - State:OK
Practice Address - Zip Code:73939
Practice Address - Country:US
Practice Address - Phone:580-349-2566
Practice Address - Fax:580-349-2983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS1413416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK690731851001OtherBCBS OF OKLAHOMA
OK=========Medicare ID - Type Unspecified