Tillman County Oklahoma Emergency

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

EMS115 Issued in OK

Legal business name

TILLMAN COUNTY OKLAHOMA EMERGENCY

Practice address

300 E Lucille Ave
Frederick, OK 73542-1422

Phone

(580) 335-5877

Fax

(580) 335-5512

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Jackie L Johnson

Title

Office Manager

Phone

(580) 335-5877

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tillman County Emergency Medical Service Dist Other name

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": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642550400000",
    "number": "1154432201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E LUCILLE AVE",
            "city": "FREDERICK",
            "state": "OK",
            "postal_code": "735421422",
            "telephone_number": "580-335-5877",
            "fax_number": "580-335-5512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E LUCILLE AVE",
            "city": "FREDERICK",
            "state": "OK",
            "postal_code": "735421422",
            "telephone_number": "580-335-5877",
            "fax_number": "580-335-5512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TILLMAN COUNTY OKLAHOMA EMERGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "580-335-5877"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "OK",
            "license": "EMS115",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100818780A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tillman County Emergency Medical Service Dist",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Billye Jean Scott
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• All providers in Frederick, OK
• Land Ambulance in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; 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.