Laverne Ambulance Service
Organization Active NPI Land Ambulance · Laverne, OK
NPI 1104829290 · NPPES record last updated Mar 25, 2009
Key facts
- NPI
- 1104829290
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- EMS118 (OK)
- Legal business name
- LAVERNE AMBULANCE SERVICE
- Practice address
- 115 N Ohio
Laverne, OK 73848 - Phone
- (580) 921-3930
- Fax
- (580) 921-3938
- NPI assigned
- May 23, 2005
- Organization subpart
- No
Authorized official
- Name
- Pauline Heinz
- Title
- Director
- Phone
- (580) 921-3930
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090323000283 | OK | Part B Supplier - Ambulance Service Supplier | 7214094093 | Practice locations: Laverne, OK |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | EMS118 | OK | Yes |
Addresses
Primary practice location
115 N Ohio
Laverne, OK 73848
Mailing address
PO Box 902
Laverne, OK 73848-0902
Phone (580) 921-3930
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100818790A | Medicaid | OK | |
| P00151922 | Other | OK | RAILROAD MEDICARE |
Other names
- Laverne EMS
Other providers in Laverne, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.