Provider Demographics
NPI:1801851472
Name:CITY OF MANNFORD
Entity Type:Organization
Organization Name:CITY OF MANNFORD
Other - Org Name:MANNFORD AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:EMTB
Authorized Official - Phone:918-865-2666
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:300 COONROD
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044-0327
Mailing Address - Country:US
Mailing Address - Phone:918-865-2666
Mailing Address - Fax:
Practice Address - Street 1:300 COONROD
Practice Address - Street 2:
Practice Address - City:MANNFORD
Practice Address - State:OK
Practice Address - Zip Code:74044
Practice Address - Country:US
Practice Address - Phone:918-865-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS0933416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100820220AMedicaid
OK=========001OtherBLUE CROSS BLUE SHIELD
OK100820220AMedicaid