Provider Demographics
NPI:1386600658
Name:MARSHALL COUNTY AMBULANCE SERVICE
Entity type:Organization
Organization Name:MARSHALL COUNTY AMBULANCE SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-795-7541
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:NUMBER 4 HOSPITAL DR
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446-0707
Mailing Address - Country:US
Mailing Address - Phone:580-795-7541
Mailing Address - Fax:580-795-3629
Practice Address - Street 1:NUMBER FOUR HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-0707
Practice Address - Country:US
Practice Address - Phone:580-795-7541
Practice Address - Fax:580-795-3629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100820160AMedicaid
OK730725620001OtherBLUE CROSS BLUE SHEILD
OK100820160AMedicaid