Provider Demographics
NPI:1710978978
Name:EMERGENCY AMBULANCE SERVICE OF ARKANSAS, INC.
Entity Type:Organization
Organization Name:EMERGENCY AMBULANCE SERVICE OF ARKANSAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMISANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-536-0734
Mailing Address - Street 1:PO BOX 5099
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71611-5099
Mailing Address - Country:US
Mailing Address - Phone:870-536-0734
Mailing Address - Fax:870-534-8378
Practice Address - Street 1:1653 S HIGHWAY 65 82
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-1661
Practice Address - Country:US
Practice Address - Phone:870-536-0734
Practice Address - Fax:870-534-8378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR407146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154526715Medicaid
AR47381Medicare ID - Type UnspecifiedPROVIDER NUMBER