Provider Demographics
NPI:1841242435
Name:SOUTHEAST EMERGENCY MEDICAL SERVICE, INC
Entity Type:Organization
Organization Name:SOUTHEAST EMERGENCY MEDICAL SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-367-2300
Mailing Address - Street 1:PO BOX 714
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71657-0714
Mailing Address - Country:US
Mailing Address - Phone:870-367-2300
Mailing Address - Fax:870-367-5062
Practice Address - Street 1:503 W GAINES ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4637
Practice Address - Country:US
Practice Address - Phone:870-367-2300
Practice Address - Fax:870-367-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0420341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance