Provider Demographics
NPI:1225260748
Name:AMITY VOLUNTEER AMBULANCE SERVICE
Entity Type:Organization
Organization Name:AMITY VOLUNTEER AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:870-828-0770
Mailing Address - Street 1:PO BOX 197
Mailing Address - Street 2:
Mailing Address - City:AMITY
Mailing Address - State:AR
Mailing Address - Zip Code:71921-0197
Mailing Address - Country:US
Mailing Address - Phone:870-342-5370
Mailing Address - Fax:
Practice Address - Street 1:121 E THOMPSON ST
Practice Address - Street 2:
Practice Address - City:AMITY
Practice Address - State:AR
Practice Address - Zip Code:71921-9685
Practice Address - Country:US
Practice Address - Phone:870-342-5371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMITY VOLUNTEER FIRE DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR801341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance