Provider Demographics
NPI:1043213010
Name:SOUTHWEST OKLAHOMA AMBULANCE AUTHORITY
Entity type:Organization
Organization Name:SOUTHWEST OKLAHOMA AMBULANCE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-688-3363
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:OK
Mailing Address - Zip Code:73550-0088
Mailing Address - Country:US
Mailing Address - Phone:918-313-7467
Mailing Address - Fax:580-688-2289
Practice Address - Street 1:1101 1/2 N 6TH
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:OK
Practice Address - Zip Code:73550
Practice Address - Country:US
Practice Address - Phone:918-313-7467
Practice Address - Fax:580-688-2289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS1173416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherBCBS PROVIDER #
OK590001072OtherRAILROAD MEDICARE
OK100818690AMedicaid