Provider Demographics
NPI:1205440575
Name:1ST INTERVENTIONS TRANSPORT
Entity type:Organization
Organization Name:1ST INTERVENTIONS TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARKANSAS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-607-9425
Mailing Address - Street 1:PO BOX 166813
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72216-6813
Mailing Address - Country:US
Mailing Address - Phone:501-607-9425
Mailing Address - Fax:
Practice Address - Street 1:14105 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:AR
Practice Address - Zip Code:72002-1824
Practice Address - Country:US
Practice Address - Phone:501-607-9424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1ST INTERVENTIONS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)