Provider Demographics
NPI:1942352299
Name:CITY OF NEWPORT OFFICE OF CITY CLERK
Entity Type:Organization
Organization Name:CITY OF NEWPORT OFFICE OF CITY CLERK
Other - Org Name:NEWPORT AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST. CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GANSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-523-3331
Mailing Address - Street 1:615 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-3217
Mailing Address - Country:US
Mailing Address - Phone:870-523-3331
Mailing Address - Fax:870-512-2101
Practice Address - Street 1:1206 HIGHWAY 367 N
Practice Address - Street 2:615 3RD STREET
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-2565
Practice Address - Country:US
Practice Address - Phone:870-523-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR288341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR288OtherSTATE LICENSE NUMBER
AR102823715Medicaid
AR102823715Medicaid