Provider Demographics
NPI:1609879717
Name:TOWN OF KEYES OKLAHOMA
Entity type:Organization
Organization Name:TOWN OF KEYES OKLAHOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-546-7651
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:KEYES
Mailing Address - State:OK
Mailing Address - Zip Code:73947-0121
Mailing Address - Country:US
Mailing Address - Phone:580-546-7651
Mailing Address - Fax:580-546-7617
Practice Address - Street 1:106 E THIRD
Practice Address - Street 2:
Practice Address - City:KEYES
Practice Address - State:OK
Practice Address - Zip Code:73947
Practice Address - Country:US
Practice Address - Phone:580-546-7651
Practice Address - Fax:580-546-7617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS3473416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100819540AMedicaid
OK731593614-001OtherBCBS PROVIDER #
OK731593614-001OtherBCBS PROVIDER #