Provider Demographics
NPI:1841340643
Name:WELEETKA GRAHAM EMS
Entity type:Organization
Organization Name:WELEETKA GRAHAM EMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ABSHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-786-2200
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:WELEETKA
Mailing Address - State:OK
Mailing Address - Zip Code:74880-0445
Mailing Address - Country:US
Mailing Address - Phone:405-786-2200
Mailing Address - Fax:
Practice Address - Street 1:115 EAST 9TH ST
Practice Address - Street 2:
Practice Address - City:WELEETKA
Practice Address - State:OK
Practice Address - Zip Code:74880-0445
Practice Address - Country:US
Practice Address - Phone:405-786-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK427146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100819030-AMedicaid
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