Provider Demographics
NPI:1801885926
Name:LAFAYETTE COUNTY AMBULANCE SERVICE INC.
Entity type:Organization
Organization Name:LAFAYETTE COUNTY AMBULANCE SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-921-5366
Mailing Address - Street 1:1416 E 6TH ST
Mailing Address - Street 2:PO BOX 737
Mailing Address - City:LEWISVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71845-8873
Mailing Address - Country:US
Mailing Address - Phone:870-921-5366
Mailing Address - Fax:870-921-5856
Practice Address - Street 1:1416 E 6TH ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:AR
Practice Address - Zip Code:71845-8873
Practice Address - Country:US
Practice Address - Phone:870-921-5366
Practice Address - Fax:870-921-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5843416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47205Medicare ID - Type UnspecifiedEMS PROVIDER