Provider Demographics
NPI:1881859718
Name:GRANDFIELD AMBULANCE SERVICE
Entity Type:Organization
Organization Name:GRANDFIELD AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:580-479-5589
Mailing Address - Street 1:103 W 3RD ST
Mailing Address - Street 2:PO BOX 655
Mailing Address - City:GRANDFIELD
Mailing Address - State:OK
Mailing Address - Zip Code:73546-9238
Mailing Address - Country:US
Mailing Address - Phone:580-479-5589
Mailing Address - Fax:580-479-5589
Practice Address - Street 1:103 W 3RD ST
Practice Address - Street 2:
Practice Address - City:GRANDFIELD
Practice Address - State:OK
Practice Address - Zip Code:73546-9238
Practice Address - Country:US
Practice Address - Phone:580-479-5589
Practice Address - Fax:580-479-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK030341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100818960AMedicaid
OKO1289OtherSUBMITTER ID NUMBER