Provider Demographics
NPI:1700889839
Name:GARBER EMERGENCY MEDICAL SERVICE (GEMS)
Entity Type:Organization
Organization Name:GARBER EMERGENCY MEDICAL SERVICE (GEMS)
Other - Org Name:GARBER EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:HAL
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-863-2961
Mailing Address - Street 1:19907 E PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:GARBER
Mailing Address - State:OK
Mailing Address - Zip Code:73738-0497
Mailing Address - Country:US
Mailing Address - Phone:580-863-2961
Mailing Address - Fax:580-863-5271
Practice Address - Street 1:19907 E PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:GARBER
Practice Address - State:OK
Practice Address - Zip Code:73738-0497
Practice Address - Country:US
Practice Address - Phone:580-863-2961
Practice Address - Fax:580-863-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS4243416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100818930AMedicaid
OK100818930AMedicaid