Provider Demographics
NPI:1881675130
Name:HOWARD COUNTY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:HOWARD COUNTY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-451-0400
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-0581
Mailing Address - Country:US
Mailing Address - Phone:870-451-0400
Mailing Address - Fax:870-451-0500
Practice Address - Street 1:120 W SYPERT ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-2430
Practice Address - Country:US
Practice Address - Phone:870-451-0400
Practice Address - Fax:870-451-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47362Medicare ID - Type Unspecified