Provider Demographics
NPI:1407875461
Name:CITY OF PEA RIDGE
Entity Type:Organization
Organization Name:CITY OF PEA RIDGE
Other - Org Name:PEA RIDGE FIRE DEPARTMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BAGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-451-1111
Mailing Address - Street 1:P.O. BOX 10
Mailing Address - Street 2:
Mailing Address - City:PEA RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72751-0010
Mailing Address - Country:US
Mailing Address - Phone:479-451-1111
Mailing Address - Fax:479-451-1105
Practice Address - Street 1:293 SOUTH CURTIS AVE
Practice Address - Street 2:
Practice Address - City:PEA RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72751-0010
Practice Address - Country:US
Practice Address - Phone:479-451-1111
Practice Address - Fax:479-451-1681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3416L0300X
AR01473416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121930715Medicaid
AR47322OtherBCBS
AR47322Medicare UPIN
AR47322OtherBCBS