Provider Demographics
NPI:1528061728
Name:CITY OF BLACKWELL
Entity type:Organization
Organization Name:CITY OF BLACKWELL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:BELIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-363-5490
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-0350
Mailing Address - Country:US
Mailing Address - Phone:580-363-7200
Mailing Address - Fax:580-363-3091
Practice Address - Street 1:221 W BLACKWELL AVE
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-2807
Practice Address - Country:US
Practice Address - Phone:580-363-7200
Practice Address - Fax:580-363-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS0313416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========-001OtherBCBS PROVIDER #
OK=========Medicare ID - Type Unspecified