Provider Demographics
NPI:1235498221
Name:PAFFORD EMERGENCY MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:PAFFORD EMERGENCY MEDICAL SERVICES, INC
Other - Org Name:PAFFORD AIR ONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.C.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-451-8036
Mailing Address - Street 1:PO BOX 1120
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71802-1120
Mailing Address - Country:US
Mailing Address - Phone:800-451-8036
Mailing Address - Fax:870-777-8479
Practice Address - Street 1:2610 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6101
Practice Address - Country:US
Practice Address - Phone:800-451-8036
Practice Address - Fax:870-777-8479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAFFORD EMERGENCY MEDICAL SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-10
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2604848Medicaid
AR194030715Medicaid
MS03174249Medicaid