City of Wewoka

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

EMS184 Issued in OK

Legal business name

CITY OF WEWOKA

Practice address

615 S Mekusukey Ave
Wewoka, OK 74884-3136

Phone

(405) 257-5421

Fax

(405) 257-7020

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

Kevin Green

Title

Fire Chief

Phone

(405) 257-5421

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wewoka Ambulance Service 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": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1790860062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1497",
            "city": "WEWOKA",
            "state": "OK",
            "postal_code": "748841497",
            "telephone_number": "405-257-5421",
            "fax_number": "405-257-7020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S MEKUSUKEY AVE",
            "city": "WEWOKA",
            "state": "OK",
            "postal_code": "748843136",
            "telephone_number": "405-257-5421",
            "fax_number": "405-257-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF WEWOKA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "405-257-5421"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "OK",
            "license": "EMS184",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100820080A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wewoka Ambulance Service",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Wewoka Ambulance Service",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Arsenio Buendia, M.D.
• Jacqueline Bush
• Kevonte Chandler
• Ahja K. Chon, M.D.
• Christopher D. Browning, D.D.S., P.C.
• Tana Lee Clark, RN
• Kirsten Leigh Colbert, LCSW
• Debra Daugomah
• Luvey Deatherage, PA-C
• Susan Dethman, CDR

• Land Ambulance in Wewoka, OK
• Providers in Wewoka, OK by specialty
• Land Ambulance in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; 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.