Provider Demographics
NPI:1902895055
Name:CITY OF JACKSONVILLE
Entity Type:Organization
Organization Name:CITY OF JACKSONVILLE
Other - Org Name:CITY OF JACKSONVILLE EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ERKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-982-4502
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72078-0126
Mailing Address - Country:US
Mailing Address - Phone:501-982-4502
Mailing Address - Fax:
Practice Address - Street 1:900 N REDMOND RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-3623
Practice Address - Country:US
Practice Address - Phone:501-985-1252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF JACKSONVILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-20
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3583416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104545715Medicaid
AR104545715Medicaid