Provider Demographics
NPI:1710091269
Name:CITY OF ERICK
Entity Type:Organization
Organization Name:CITY OF ERICK
Other - Org Name:ERICK AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FORGAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-526-3924
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:206 S SHEB WOOLEY
Mailing Address - City:ERICK
Mailing Address - State:OK
Mailing Address - Zip Code:73645-0025
Mailing Address - Country:US
Mailing Address - Phone:580-526-3924
Mailing Address - Fax:580-526-3830
Practice Address - Street 1:415 E ROGER MILLER
Practice Address - Street 2:
Practice Address - City:ERICK
Practice Address - State:OK
Practice Address - Zip Code:73645-0025
Practice Address - Country:US
Practice Address - Phone:580-526-3924
Practice Address - Fax:580-526-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS0343416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100819750AMedicaid
OK100819750AMedicaid
=========Medicare PIN
OK=========-001OtherBC/BS