Provider Demographics
NPI:1861454506
Name:CITY OF FAIRFIELD BAY
Entity Type:Organization
Organization Name:CITY OF FAIRFIELD BAY
Other - Org Name:CITY OF FAIRFIELD BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALOUPEK
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:501-884-6006
Mailing Address - Street 1:PO BOX 1271
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD BAY
Mailing Address - State:AR
Mailing Address - Zip Code:72088-1271
Mailing Address - Country:US
Mailing Address - Phone:501-884-6006
Mailing Address - Fax:
Practice Address - Street 1:101 LITTLE ROCK DRIVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD BAY
Practice Address - State:AR
Practice Address - Zip Code:72088-1271
Practice Address - Country:US
Practice Address - Phone:501-884-6006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR248341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARNEIC AR047OtherAMBULANCE SERVICE
AR133442715Medicaid
ARNEIC AR047OtherAMBULANCE SERVICE