Provider Demographics
NPI:1558380725
Name:SEBASTIAN COUNTY JUDGE COURTHOUSE
Entity Type:Organization
Organization Name:SEBASTIAN COUNTY JUDGE COURTHOUSE
Other - Org Name:SEBASTIAN COUNTY EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY JUDGE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:O
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-783-6139
Mailing Address - Street 1:PO BOX 1682
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72902-1682
Mailing Address - Country:US
Mailing Address - Phone:479-783-1095
Mailing Address - Fax:479-784-1588
Practice Address - Street 1:35 S 6TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-2421
Practice Address - Country:US
Practice Address - Phone:479-783-1095
Practice Address - Fax:479-784-1588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7183416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47319OtherBLUE CROSS BLUE SHIELD
AR105704715Medicaid
AR47319OtherBLUE CROSS BLUE SHIELD