Provider Demographics
NPI:1578647475
Name:METRO AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:METRO AMBULANCE SERVICE INC
Other - Org Name:AMERICAN MEDICAL RESPONSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-495-1220
Mailing Address - Street 1:PO BOX 847925
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2303 S 8TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1012
Practice Address - Country:US
Practice Address - Phone:479-986-9866
Practice Address - Fax:479-986-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR164389715Medicaid
ARAR0000D100477OtherSECTION 1011
AR164389715Medicaid