Organization
CITY OF KONAWA
Active
Other names
KONAWA EMS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JESSE MATTHEW BROGDON EMT INTERMEDIATE (EMS DIRECTOR/ADMINISTRATOR)
(580) 925-2345
Entity
Organization
Contact information
Practice address
122 N BROADWAY ST, KONAWA, OK 74849-2232
(580) 925-2345
(580) 925-3131
Mailing address
122 N BROADWAY ST, KONAWA, OK 74849-2232
(580) 925-2345
(580) 925-3131
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
EMS 011
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100818800A
—
OK
Enumeration date
09/21/2010
Last updated
09/21/2010
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