Organization
CITY OF WAGONER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES ROBERTS (SUPERVISOR)
(800) 538-8278
Entity
Organization
Contact information
Practice address
300 SE 3RD ST, WAGONER, OK 74467-5726
(800) 538-8278
(580) 628-2273
Mailing address
PO BOX 406, WAGONER, OK 74477-0406
(800) 538-8278
(580) 628-2273
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
EMS014
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100818530A
—
OK
01
—
731011975001
BCBS PROVIDER NUMBER
OK
Enumeration date
10/26/2006
Last updated
12/14/2009
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