Active NPI
Southwest Oklahoma Ambulance Authority
- Land Ambulance
- Hollis, OK
National Provider Identifier
1043213010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- License
- EMS117
- Legal business name
- SOUTHWEST OKLAHOMA AMBULANCE AUTHORITY
- Practice address
- 1101 1/2 N 6TH
Hollis, OK 73550 - Phone
- (918) 313-7467
- Fax
- (580) 688-2289
- NPI assigned
- May 24, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Eddie James Watson
- Title
- Director
- Phone
- (580) 688-3363
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | EMS117 | OK | Primary |
Addresses
Primary practice location
1101 1/2 N 6TH
Hollis, OK 73550
Mailing address
PO Box 88
Hollis, OK 73550-0088
Phone (918) 313-7467
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ========= | Other | OK | BCBS PROVIDER # |
| 590001072 | Other | OK | RAILROAD MEDICARE |
| 100818690A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090218000558 | OK | Part B Supplier - Ambulance Service Supplier | 2860557238 | Practice locations: Hollis, OK |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1739318400000",
"number": "1043213010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 88",
"city": "HOLLIS",
"state": "OK",
"postal_code": "735500088",
"telephone_number": "918-313-7467",
"fax_number": "580-688-2289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 1/2 N 6TH",
"city": "HOLLIS",
"state": "OK",
"postal_code": "73550",
"telephone_number": "918-313-7467",
"fax_number": "580-688-2289"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHWEST OKLAHOMA AMBULANCE AUTHORITY",
"organizational_subpart": "NO",
"enumeration_date": "2005-05-24",
"last_updated": "2025-02-12",
"status": "A",
"authorized_official_last_name": "WATSON",
"authorized_official_first_name": "EDDIE",
"authorized_official_middle_name": "JAMES",
"authorized_official_title_or_position": "DIRECTOR",
"authorized_official_telephone_number": "580-688-3363"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "OK",
"license": "EMS117",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER #",
"identifier": "=========",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "590001072",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100818690A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hollis, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.