1396847166 NPI number — CENTRAL EMERGENCY MEDICAL SERVICE, INC.

Table of content: (NPI 1396847166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396847166 NPI number — CENTRAL EMERGENCY MEDICAL SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL EMERGENCY MEDICAL 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:
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:
1396847166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
645 S SCHOOL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72701-6470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-521-5801
Provider Business Mailing Address Fax Number:
479-521-1690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
645 S SCHOOL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72701-6470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-521-5801
Provider Business Practice Location Address Fax Number:
479-521-1690
Provider Enumeration Date:
09/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HICKERSON
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
479-521-5801

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  146 , 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: 807826102 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100817780A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106403715 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com