Provider Demographics
NPI:1174868673
Name:FREEDOM VOLUNTEER AMBULANCE SERVICE
Entity type:Organization
Organization Name:FREEDOM VOLUNTEER AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEBBLES
Authorized Official - Middle Name:
Authorized Official - Last Name:LUDDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:NREMTB
Authorized Official - Phone:580-621-3302
Mailing Address - Street 1:404 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:OK
Mailing Address - Zip Code:73842-0173
Mailing Address - Country:US
Mailing Address - Phone:580-621-3302
Mailing Address - Fax:580-621-3309
Practice Address - Street 1:1049 MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:OK
Practice Address - Zip Code:73842-0173
Practice Address - Country:US
Practice Address - Phone:580-621-3302
Practice Address - Fax:580-621-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty