1396736559 NPI number — EMERGENCY AMBULANCE SERVICE, INC.

Table of content: MS. KIM RENEE PULLIAM LCSW (NPI 1215353081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396736559 NPI number — EMERGENCY AMBULANCE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY AMBULANCE SERVICE, INC.
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:
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:
1396736559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5099
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINE BLUFF
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71611-5099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-536-0734
Provider Business Mailing Address Fax Number:
870-534-8378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINE BLUFF
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71601-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-536-0734
Provider Business Practice Location Address Fax Number:
870-534-8378
Provider Enumeration Date:
11/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PALMISANO
Authorized Official First Name:
LEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
870-536-0734

Provider Taxonomy Codes

  • Taxonomy code: 146L00000X , with the licence number:  459 , 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: 101581715 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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