Provider Demographics
NPI:1750424750
Name:APACHE AMBULANCE SERVICE INC.
Entity type:Organization
Organization Name:APACHE AMBULANCE SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-588-3305
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:APACHE
Mailing Address - State:OK
Mailing Address - Zip Code:73006-0200
Mailing Address - Country:US
Mailing Address - Phone:580-588-3305
Mailing Address - Fax:580-588-3305
Practice Address - Street 1:725 S COBLAKE ST
Practice Address - Street 2:
Practice Address - City:APACHE
Practice Address - State:OK
Practice Address - Zip Code:73006-8334
Practice Address - Country:US
Practice Address - Phone:580-588-3305
Practice Address - Fax:580-588-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS2103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100818920AMedicaid
OKO1569Medicare ID - Type Unspecified