Provider Demographics
NPI:1902252901
Name:RANCIFER, SYDNEY RAY
Entity Type:Individual
Prefix:MR
First Name:SYDNEY
Middle Name:RAY
Last Name:RANCIFER
Suffix:
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:VERONICA
Other - Middle Name:HARRIS
Other - Last Name:RANCIFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:719 SEDGEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-8336
Mailing Address - Country:US
Mailing Address - Phone:501-280-9900
Mailing Address - Fax:501-280-9901
Practice Address - Street 1:719 SEDGEFIELD DR
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-8336
Practice Address - Country:US
Practice Address - Phone:501-280-9900
Practice Address - Fax:501-280-9901
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR527343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)