Provider Demographics
NPI:1124003850
Name:ARKANSAS EMERGENCY TRANSPORT, LLC
Entity Type:Organization
Organization Name:ARKANSAS EMERGENCY TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-982-5912
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72078-0339
Mailing Address - Country:US
Mailing Address - Phone:501-982-5912
Mailing Address - Fax:501-985-9912
Practice Address - Street 1:2003 MILITARY ROAD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076
Practice Address - Country:US
Practice Address - Phone:501-982-5912
Practice Address - Fax:501-985-9912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR301341600000X
AR306341600000X
AR225341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR48861OtherBCBS
AR=========30OtherQUALCHOICE OF ARKANSAS
AR48861Medicare PIN