1578647475 NPI number — METRO AMBULANCE SERVICE INC

Table of content: (NPI 1578647475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578647475 NPI number — METRO AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO 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:
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:
1578647475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 847925
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-7925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2303 S 8TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72758-1012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-986-9866
Provider Business Practice Location Address Fax Number:
479-986-8096
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRUNING
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
303-495-1220

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 164389715 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: AR0000D100477 . This is a "SECTION 1011" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com