Provider Demographics
NPI:1376606053
Name:TRUMANN AMBULANCE SERVICE
Entity Type:Organization
Organization Name:TRUMANN AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-483-6441
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:TRUMANN
Mailing Address - State:AR
Mailing Address - Zip Code:72472-0081
Mailing Address - Country:US
Mailing Address - Phone:870-483-6441
Mailing Address - Fax:870-483-7840
Practice Address - Street 1:408 JADEN COVE
Practice Address - Street 2:
Practice Address - City:TRUMANN
Practice Address - State:AR
Practice Address - Zip Code:72472
Practice Address - Country:US
Practice Address - Phone:870-483-6441
Practice Address - Fax:870-483-7840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06353416L0300X
AR06363416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0636OtherSERVICE LICENSE FOR AR
AR164382715Medicaid
AR0635OtherSERVICE LICENSE FOR AR
AR164382715Medicaid