Provider Demographics
NPI:1639591498
Name:SOUTHERN LIFECARE EMERGENCY MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHERN LIFECARE EMERGENCY MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WILTON
Authorized Official - Last Name:PADGET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-734-3366
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:BRINKLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72021-0802
Mailing Address - Country:US
Mailing Address - Phone:870-734-3366
Mailing Address - Fax:870-589-2206
Practice Address - Street 1:210 N NEW ORLEANS AVE
Practice Address - Street 2:
Practice Address - City:BRINKLEY
Practice Address - State:AR
Practice Address - Zip Code:72021-2812
Practice Address - Country:US
Practice Address - Phone:870-734-3366
Practice Address - Fax:870-589-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance