Provider Demographics
NPI:1285672659
Name:MED-TECH EMS OF CONWAY CO, INC.
Entity Type:Organization
Organization Name:MED-TECH EMS OF CONWAY CO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MARGO
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, EMT-I
Authorized Official - Phone:501-354-8181
Mailing Address - Street 1:10 MEDICAL SERVICES DR
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-4518
Mailing Address - Country:US
Mailing Address - Phone:501-354-8181
Mailing Address - Fax:501-354-1420
Practice Address - Street 1:10 MEDICAL SERVICES DR
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4518
Practice Address - Country:US
Practice Address - Phone:501-354-8181
Practice Address - Fax:501-354-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47030OtherBLUE CROSS BLUE SHIELD
AR118801715Medicaid