Organization
CITY OF CHECOTAH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY LEWIS (AMBULANCE DIRECTOR)
(918) 473-5411
Entity
Organization
Contact information
Practice address
414 W GENTRY AVE, CHECOTAH, OK 74426-2444
(800) 538-8278
(580) 628-2273
Mailing address
414 W GENTRY AVE, CHECOTAH, OK 74426-2444
(800) 538-8278
(580) 628-2273
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
EMS174
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100819660A
—
OK
01
—
590120561
RRMC PROVIDER NUMBER
OK
Enumeration date
09/21/2006
Last updated
01/05/2010
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