Provider Demographics
NPI:1689853319
Name:CITY OF STILWELL
Entity Type:Organization
Organization Name:CITY OF STILWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:MARIANNE
Authorized Official - Last Name:KETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-696-6443
Mailing Address - Street 1:503 W DIVISION
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960
Mailing Address - Country:US
Mailing Address - Phone:918-696-7209
Mailing Address - Fax:918-696-6209
Practice Address - Street 1:20 1/2 W. WALNUT
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960
Practice Address - Country:US
Practice Address - Phone:918-696-7209
Practice Address - Fax:918-696-8745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK341600000X
OKEMS095341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100817670AMedicaid
OK690730305-001OtherBLUE CROSS/BLUE SHIELD
OK100817670AMedicaid
OK690730305Medicare UPIN