Provider Demographics
NPI:1205080025
Name:CITY OF WAURIKA
Entity type:Organization
Organization Name:CITY OF WAURIKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-228-2713
Mailing Address - Street 1:122 S. MAIN
Mailing Address - Street 2:
Mailing Address - City:WAURIKA
Mailing Address - State:OK
Mailing Address - Zip Code:73573
Mailing Address - Country:US
Mailing Address - Phone:580-228-2713
Mailing Address - Fax:580-228-2489
Practice Address - Street 1:122 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAURIKA
Practice Address - State:OK
Practice Address - Zip Code:73573-3054
Practice Address - Country:US
Practice Address - Phone:580-228-2713
Practice Address - Fax:580-228-2489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF WAURIKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-06
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS1723416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1205080025Medicare PIN