Provider Demographics
NPI:1891738548
Name:CITY OF CROSSETT
Entity Type:Organization
Organization Name:CITY OF CROSSETT
Other - Org Name:CROSSETT FIRE DEPT/CROSSETT AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-364-4134
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-0560
Mailing Address - Country:US
Mailing Address - Phone:870-364-4134
Mailing Address - Fax:870-364-5634
Practice Address - Street 1:309 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635
Practice Address - Country:US
Practice Address - Phone:870-364-4134
Practice Address - Fax:870-364-5634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4883416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100954715Medicaid
AR47077OtherBCBS & ALL OTHER INSURANC
AR47077Medicare PIN