Provider Demographics
NPI:1639375306
Name:CITY OF TYRONZA, ARK
Entity type:Organization
Organization Name:CITY OF TYRONZA, ARK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RECORDER/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-487-2168
Mailing Address - Street 1:200 S MAIN
Mailing Address - Street 2:
Mailing Address - City:TYRONZA
Mailing Address - State:AR
Mailing Address - Zip Code:72386
Mailing Address - Country:US
Mailing Address - Phone:870-487-2168
Mailing Address - Fax:
Practice Address - Street 1:200 S MAIN
Practice Address - Street 2:
Practice Address - City:TYRONZA
Practice Address - State:AR
Practice Address - Zip Code:72386
Practice Address - Country:US
Practice Address - Phone:870-487-2168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR621341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120890715Medicaid
AR47164OtherBLUECROSS BLUESHIELD
AR47164Medicare ID - Type Unspecified