1023055118 NPI number — AMBULANCE SERVICES OF FORREST CITY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023055118 NPI number — AMBULANCE SERVICES OF FORREST CITY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMBULANCE SERVICES OF FORREST CITY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023055118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 NEW CASTLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORREST CITY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72335-2218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-630-9611
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 NEW CASTLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORREST CITY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72335-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-630-9611
Provider Business Practice Location Address Fax Number:
870-630-9657
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FEY
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR, CLINIC REVENUE CYCLE
Authorized Official Telephone Number:
615-221-3641

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  640 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , with the licence number: 619 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 160796715 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 619 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 640 . This is a "STATE LICENSE-SECOND LOCATION" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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