Provider Demographics
NPI:1548257470
Name:ARKANSAS PARAMEDIC TRANSPORT
Entity type:Organization
Organization Name:ARKANSAS PARAMEDIC TRANSPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:R N
Authorized Official - Phone:479-621-3998
Mailing Address - Street 1:1901 N 13TH ST
Mailing Address - Street 2:P O BOX 696
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-2317
Mailing Address - Country:US
Mailing Address - Phone:479-621-3998
Mailing Address - Fax:479-631-8409
Practice Address - Street 1:1901 N 13TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-2317
Practice Address - Country:US
Practice Address - Phone:479-621-3998
Practice Address - Fax:479-631-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1693416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47386Medicare ID - Type UnspecifiedAMBULANCE