Provider Demographics
NPI:1689037707
Name:ELITE EMS OF ARKANSAS
Entity Type:Organization
Organization Name:ELITE EMS OF ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARAMEDIC
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-979-7039
Mailing Address - Street 1:15 LAKEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-9020
Mailing Address - Country:US
Mailing Address - Phone:479-979-7039
Mailing Address - Fax:
Practice Address - Street 1:15 LAKEVIEW CIR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-9020
Practice Address - Country:US
Practice Address - Phone:479-979-7039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance