Provider Demographics
NPI:1750481578
Name:ANGEL CARE EMS OF CRAWFORD COUNTY, INC
Entity Type:Organization
Organization Name:ANGEL CARE EMS OF CRAWFORD COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:MARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-474-9907
Mailing Address - Street 1:718 CLOVERLEAF CIR
Mailing Address - Street 2:P O BOX 5641
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5060
Mailing Address - Country:US
Mailing Address - Phone:479-474-9907
Mailing Address - Fax:479-474-9903
Practice Address - Street 1:718 CLOVERLEAF CIR
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5060
Practice Address - Country:US
Practice Address - Phone:479-474-9907
Practice Address - Fax:479-474-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR736341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47336OtherBC/BS
AR47336OtherBC/BS