Provider Demographics
NPI:1558638437
Name:SOUTHERN OKLAHOMA LIFELINE LLC
Entity Type:Organization
Organization Name:SOUTHERN OKLAHOMA LIFELINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-421-2414
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74821-0592
Mailing Address - Country:US
Mailing Address - Phone:580-421-2414
Mailing Address - Fax:580-332-1074
Practice Address - Street 1:107 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5401
Practice Address - Country:US
Practice Address - Phone:580-421-2414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies