Provider Demographics
NPI:1699833798
Name:WALTERS VOLUNTEER AMBULANCE
Entity Type:Organization
Organization Name:WALTERS VOLUNTEER AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:FRYER
Authorized Official - Suffix:
Authorized Official - Credentials:RN EMT DIRECTOR
Authorized Official - Phone:580-875-2400
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:WALTERS
Mailing Address - State:OK
Mailing Address - Zip Code:73572-2032
Mailing Address - Country:US
Mailing Address - Phone:580-875-2400
Mailing Address - Fax:580-875-3574
Practice Address - Street 1:119 S BROADWAY
Practice Address - Street 2:
Practice Address - City:WALTERS
Practice Address - State:OK
Practice Address - Zip Code:73572-2032
Practice Address - Country:US
Practice Address - Phone:580-875-2400
Practice Address - Fax:580-875-3574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS1983416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100818300AMedicaid
OK100818300AMedicaid