Provider Demographics
NPI:1538116058
Name:BRYAN COUNTY AMBULANCE AUTHORITY
Entity type:Organization
Organization Name:BRYAN COUNTY AMBULANCE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-924-4687
Mailing Address - Street 1:306 S 22ND AVE
Mailing Address - Street 2:P.O. BOX 1
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-5647
Mailing Address - Country:US
Mailing Address - Phone:580-924-4687
Mailing Address - Fax:580-924-4688
Practice Address - Street 1:306 S 22ND AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-5647
Practice Address - Country:US
Practice Address - Phone:580-924-4687
Practice Address - Fax:580-924-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS1283416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKO0792Medicare UPIN