Provider Demographics
NPI:1558664615
Name:EAGLE MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:EAGLE MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAYLL
Authorized Official - Middle Name:K
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:405-279-3126
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:MEEKER
Mailing Address - State:OK
Mailing Address - Zip Code:74855-0528
Mailing Address - Country:US
Mailing Address - Phone:405-279-3126
Mailing Address - Fax:
Practice Address - Street 1:342968 E 1025 RD
Practice Address - Street 2:
Practice Address - City:MEEKER
Practice Address - State:OK
Practice Address - Zip Code:74855-9205
Practice Address - Country:US
Practice Address - Phone:405-279-3126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS455341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance