Organization
CITY OF STILWELL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KARIN MARIANNE KETCHER (DIRECTOR)
(918) 696-6443
Entity
Organization
Contact information
Practice address
20 1/2 W. WALNUT, STILWELL, OK 74960
(918) 696-7209
(918) 696-8745
Mailing address
503 W DIVISION, STILWELL, OK 74960
(918) 696-7209
(918) 696-6209
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
EMS095
OK
341600000X
Ambulance
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100817670A
—
OK
01
—
690730305-001
BLUE CROSS/BLUE SHIELD
OK
Enumeration date
10/30/2007
Last updated
06/11/2010
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