Provider Demographics
NPI:1689898330
Name:CITY OF BALD KNOB
Entity Type:Organization
Organization Name:CITY OF BALD KNOB
Other - Org Name:BALD KNOB VOLUNTEER AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BERTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:501-724-6897
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:BALD KNOB
Mailing Address - State:AR
Mailing Address - Zip Code:72010-0671
Mailing Address - Country:US
Mailing Address - Phone:501-724-6897
Mailing Address - Fax:501-724-3439
Practice Address - Street 1:3713 HWY 367 N
Practice Address - Street 2:
Practice Address - City:BALD KNOB
Practice Address - State:AR
Practice Address - Zip Code:72010
Practice Address - Country:US
Practice Address - Phone:501-724-6897
Practice Address - Fax:501-724-3439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR02633416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47134Medicare ID - Type Unspecified