Provider Demographics
NPI:1740405117
Name:TOWN OF COLBERT
Entity Type:Organization
Organization Name:TOWN OF COLBERT
Other - Org Name:COLBERT EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:PARAMEDIC/EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-889-1529
Mailing Address - Street 1:PO BOX 646021
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75264-6021
Mailing Address - Country:US
Mailing Address - Phone:580-296-2000
Mailing Address - Fax:580-296-2100
Practice Address - Street 1:705 MOORE AVE
Practice Address - Street 2:
Practice Address - City:COLBERT
Practice Address - State:OK
Practice Address - Zip Code:74733
Practice Address - Country:US
Practice Address - Phone:580-296-2000
Practice Address - Fax:580-296-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK125341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100818390AMedicaid
OK=========-001OtherBCBS OF OKLAHOMA