Provider Demographics
NPI:1336111335
Name:EMERSON AMBULANCE SERVICE, INC
Entity Type:Organization
Organization Name:EMERSON AMBULANCE SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-935-0380
Mailing Address - Street 1:1703 E NETTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5165
Mailing Address - Country:US
Mailing Address - Phone:870-935-0380
Mailing Address - Fax:870-268-8466
Practice Address - Street 1:1703 E NETTLETON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5165
Practice Address - Country:US
Practice Address - Phone:870-935-0380
Practice Address - Fax:870-268-8466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6433416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47128Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER