Organization
SE EMS OF OKLAHOMA, LLC
Active
Other names
SOUTHEAST EMS
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CONNIE J NEWBOLT (PRESIDENT)
(918) 315-0886
Entity
Organization
Contact information
Practice address
30177 W CHOCTAW RD, STIGLER, OK 74462-3558
(479) 243-9819
Mailing address
PO BOX 1800, MENA, AR 71953-1800
(479) 243-9819
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
803
AR
3416L0300X
Land Ambulance
Primary
EMS-459
OK
3416L0300X
Land Ambulance
EMS-479
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200412300A
—
OK
05
—
210183715
—
AR
Enumeration date
08/18/2010
Last updated
03/16/2017
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