Provider Demographics
NPI:1831263474
Name:MERCY HEALTH - LOVE COUNTY EMS
Entity type:Organization
Organization Name:MERCY HEALTH - LOVE COUNTY EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:W
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CALLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-276-3347
Mailing Address - Street 1:300 WANDA ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OK
Mailing Address - Zip Code:73448-1200
Mailing Address - Country:US
Mailing Address - Phone:580-276-3347
Mailing Address - Fax:580-276-2182
Practice Address - Street 1:300 WANDA ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OK
Practice Address - Zip Code:73448-1200
Practice Address - Country:US
Practice Address - Phone:580-276-3347
Practice Address - Fax:580-276-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK312341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371306Medicare ID - Type UnspecifiedPROVIDER NUMBER