Provider Demographics
NPI:1871647750
Name:CITY OF COLLINSVILLE
Entity Type:Organization
Organization Name:CITY OF COLLINSVILLE
Other - Org Name:CITY OF COLLINSVILLE EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JILIAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-371-1031
Mailing Address - Street 1:1214 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-3115
Mailing Address - Country:US
Mailing Address - Phone:918-371-1031
Mailing Address - Fax:918-371-1030
Practice Address - Street 1:1214 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-3115
Practice Address - Country:US
Practice Address - Phone:918-371-1031
Practice Address - Fax:918-371-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK333416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100819700AMedicaid
OK100819700AMedicaid
OK=========001OtherBLUE CROSS BLUE SHIELD