Provider Demographics
NPI:1760184592
Name:BOSTON, RONALD ONEAL
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ONEAL
Last Name:BOSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 KENTUCKY CIRCLE
Mailing Address - Street 2:LITTLE ROCK AFB
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076
Mailing Address - Country:US
Mailing Address - Phone:501-575-7490
Mailing Address - Fax:
Practice Address - Street 1:184 KENTUCKY CIRCLE
Practice Address - Street 2:LITTLE ROCK AFB
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076
Practice Address - Country:US
Practice Address - Phone:501-575-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR347E00000X
AR900118788343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker