Provider Demographics
NPI:1710197223
Name:PRIM FIRE & E.M.S., INC.
Entity Type:Organization
Organization Name:PRIM FIRE & E.M.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-948-2636
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:PRIM
Mailing Address - State:AR
Mailing Address - Zip Code:72130-0105
Mailing Address - Country:US
Mailing Address - Phone:870-948-2636
Mailing Address - Fax:870-948-2633
Practice Address - Street 1:4119 PRIM RD
Practice Address - Street 2:
Practice Address - City:PRIM
Practice Address - State:AR
Practice Address - Zip Code:72130
Practice Address - Country:US
Practice Address - Phone:870-948-2636
Practice Address - Fax:870-948-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2953416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135947715Medicaid
AR135947715Medicaid