Provider Demographics
NPI:1609886522
Name:FORT SMITH EMERGENCY MEDICAL SERVICES
Entity Type:Organization
Organization Name:FORT SMITH EMERGENCY MEDICAL SERVICES
Other - Org Name:FT SMITH EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CHARLENE
Authorized Official - Last Name:FOUGHTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-783-1078
Mailing Address - Street 1:PO BOX 180010
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72918-8313
Mailing Address - Country:US
Mailing Address - Phone:479-783-1078
Mailing Address - Fax:479-783-2913
Practice Address - Street 1:3417 DUKE AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8313
Practice Address - Country:US
Practice Address - Phone:479-783-1078
Practice Address - Fax:479-783-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0727341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105862715Medicaid
AR105862715Medicaid