Provider Demographics
NPI:1043420094
Name:CRITTENDEN AMBULANCE SERVICE CORP
Entity Type:Organization
Organization Name:CRITTENDEN AMBULANCE SERVICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:REVELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-451-8036
Mailing Address - Street 1:PO BOX 3127
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72303-3127
Mailing Address - Country:US
Mailing Address - Phone:800-451-8036
Mailing Address - Fax:870-777-8479
Practice Address - Street 1:510 E JACKSON AVE
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4336
Practice Address - Country:US
Practice Address - Phone:800-451-8036
Practice Address - Fax:870-777-8479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR633341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47153OtherARKANSAS BCBS
AR47153Medicare ID - Type Unspecified