Provider Demographics
NPI:1023055118
Name:AMBULANCE SERVICES OF FORREST CITY LLC
Entity type:Organization
Organization Name:AMBULANCE SERVICES OF FORREST CITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CLINIC REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3641
Mailing Address - Street 1:1601 NEW CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-2218
Mailing Address - Country:US
Mailing Address - Phone:870-630-9611
Mailing Address - Fax:
Practice Address - Street 1:1601 NEW CASTLE RD
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-2218
Practice Address - Country:US
Practice Address - Phone:870-630-9611
Practice Address - Fax:870-630-9657
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBULANCE SERVICES OF FORREST CITY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-31
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR640341600000X
AR619341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160796715Medicaid
AR619OtherSTATE LICENSE NUMBER
AR640OtherSTATE LICENSE-SECOND LOCATION
AR619OtherSTATE LICENSE NUMBER