Provider Demographics
NPI:1396847166
Name:CENTRAL EMERGENCY MEDICAL SERVICE, INC.
Entity Type:Organization
Organization Name:CENTRAL EMERGENCY MEDICAL SERVICE, INC.
Other - Org Name:CENTRAL EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:HICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-521-5801
Mailing Address - Street 1:645 S SCHOOL AVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-6470
Mailing Address - Country:US
Mailing Address - Phone:479-521-5801
Mailing Address - Fax:479-521-1690
Practice Address - Street 1:645 S SCHOOL AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-6470
Practice Address - Country:US
Practice Address - Phone:479-521-5801
Practice Address - Fax:479-521-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR146341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO807826102Medicaid
OK100817780AMedicaid
AR106403715Medicaid
AR106403715Medicaid