| Organization Name: | CITY OF KONAWA |
| NPI Number: | 1548578891 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JESSE MATTHEW BROGDON (EMS DIRECTOR/ADMINISTRATOR) |
| Mailing Address: | 122 N Broadway St Konawa |
| State: | OK US |
| Postal Code: | 748492232 |
| Phone Number: | 5809252345 |
| Fax Number: | 5809253131 |
| NPI Enumeration Date: | 09/21/2010 |
| NPI Last Update Date: | 09/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | EMS 011 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |