Canton-Longdale EMS District
Organization Active NPI Land Ambulance · Canton, OK
NPI 1972656205 · NPPES record last updated Nov 17, 2023
Key facts
- NPI
- 1972656205
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- EMS111 (OK)
- Legal business name
- CANTON-LONGDALE EMS DISTRICT
- Practice address
- #2 Depot Rd
Canton, OK 73724-0039 - Phone
- (580) 886-2515
- NPI assigned
- Jan 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Connie Lea Sprunger
- Title
- Office Manager
- Phone
- (580) 886-2515
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120620000744 | OK | Part B Supplier - Ambulance Service Supplier | 0345404463 | Practice locations: Canton, OK |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | EMS111 | OK | Yes |
Addresses
Primary practice location
#2 Depot Rd
Canton, OK 73724-0039
Mailing address
PO Box 39
Canton, OK 73724-0039
Phone (580) 886-2515
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100818600A | Medicaid | OK |
Other providers in Canton, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 17, 2023. 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.