Provider Demographics
NPI:1154538494
Name:BUTLER EMS SERVICES
Entity type:Organization
Organization Name:BUTLER EMS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-664-3101
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:OK
Mailing Address - Zip Code:73625-0145
Mailing Address - Country:US
Mailing Address - Phone:580-664-3915
Mailing Address - Fax:
Practice Address - Street 1:105 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:OK
Practice Address - Zip Code:73625-0145
Practice Address - Country:US
Practice Address - Phone:580-664-3915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS355146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200070800AMedicaid
OK=========-001OtherBLUE CROSS BLUE SHIELD
OK200070800AMedicaid