City of Wagoner

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

EMS014 Issued in OK

Legal business name

CITY OF WAGONER

Practice address

300 SE 3Rd St
Wagoner, OK 74467-5726

Phone

(800) 538-8278

Fax

(580) 628-2273

NPI assigned

Oct 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

James Roberts

Title

Supervisor

Phone

(800) 538-8278

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260748800000",
    "number": "1093890352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 406",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744770406",
            "telephone_number": "800-538-8278",
            "fax_number": "580-628-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 SE 3RD ST",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744675726",
            "telephone_number": "800-538-8278",
            "fax_number": "580-628-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF WAGONER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2009-12-14",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "800-538-8278"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "OK",
            "license": "EMS014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "731011975001",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100818530A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Casey Hanna MD Professional Corporation
• Glennda Catlett
• Lisette Caveny, CM-A
• Karla Maria Chavez
• Lori Kim Childs, LMSW-P
• Brenda Gayle Clark
• Michael D Clark, PT
• Sylvia Clark
• Jeremiah Thomas Cleveland
• Gayle Cline, OTR

• All providers in Wagoner, OK
• Land Ambulance in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2009; 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.

Verify at the official NPI Registry.