Provider Demographics
NPI:1568456689
Name:ELDORADO EMERGENCY MEDICAL SERVICE
Entity Type:Organization
Organization Name:ELDORADO EMERGENCY MEDICAL SERVICE
Other - Org Name:ELDORADO EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANICAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOODIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-633-2404
Mailing Address - Street 1:501 WEST C
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:OK
Mailing Address - Zip Code:73537-0043
Mailing Address - Country:US
Mailing Address - Phone:580-633-2404
Mailing Address - Fax:
Practice Address - Street 1:501 WEST C ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:OK
Practice Address - Zip Code:73537-0043
Practice Address - Country:US
Practice Address - Phone:580-633-2404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS103146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty