Provider Demographics
NPI:1922745215
Name:LITTLE ROCK EMERGENCY MEDICAL SERVICE
Entity Type:Organization
Organization Name:LITTLE ROCK EMERGENCY MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER AT LARGE
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, EMT
Authorized Official - Phone:712-720-0288
Mailing Address - Street 1:402 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:IA
Mailing Address - Zip Code:51243-1031
Mailing Address - Country:US
Mailing Address - Phone:712-479-2852
Mailing Address - Fax:
Practice Address - Street 1:402 MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:IA
Practice Address - Zip Code:51243-1031
Practice Address - Country:US
Practice Address - Phone:712-479-2852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF LITTLE ROCK, IOWA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport