Provider Demographics
NPI:1598768335
Name:JACKSON COUNTY EMERGENCY MEDICAL SERVICE DISTRICT
Entity Type:Organization
Organization Name:JACKSON COUNTY EMERGENCY MEDICAL SERVICE DISTRICT
Other - Org Name:JACKSON COUNTY EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SAVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-477-4112
Mailing Address - Street 1:1309 N PARK LN
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-4552
Mailing Address - Country:US
Mailing Address - Phone:580-477-4112
Mailing Address - Fax:580-477-1070
Practice Address - Street 1:1309 N PARK LN
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-4552
Practice Address - Country:US
Practice Address - Phone:580-477-4112
Practice Address - Fax:580-477-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS2383416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100819040AMedicaid
OK=========Medicare PIN