Provider Demographics
NPI:1831272145
Name:SPRING RIVER PARAMEDIC AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:SPRING RIVER PARAMEDIC AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:EASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-994-0790
Mailing Address - Street 1:4 NAVAJO CTR
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72529-7610
Mailing Address - Country:US
Mailing Address - Phone:870-994-0790
Mailing Address - Fax:870-994-0792
Practice Address - Street 1:4 NAVAJO CTR
Practice Address - Street 2:
Practice Address - City:CHEROKEE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:72529-7610
Practice Address - Country:US
Practice Address - Phone:870-994-0790
Practice Address - Fax:870-994-0792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR02303416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO801640806OtherMO MEDICAID
AR105964715Medicaid
AR3416L0300XMedicaid
AR105964715Medicaid