Provider Demographics
NPI:1639198989
Name:CITY OF JAY
Entity Type:Organization
Organization Name:CITY OF JAY
Other - Org Name:CITY OF JAY EMS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF EMS
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DAKOTA
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:NRP
Authorized Official - Phone:918-253-6198
Mailing Address - Street 1:P.O. BOX 348
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-0348
Mailing Address - Country:US
Mailing Address - Phone:918-253-4148
Mailing Address - Fax:918-253-2286
Practice Address - Street 1:211 S. 5TH ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346
Practice Address - Country:US
Practice Address - Phone:918-253-6198
Practice Address - Fax:918-253-2286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2003416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100819830AMedicaid
OK100819830AMedicaid
OK=========Medicare ID - Type Unspecified