Provider Demographics
NPI:1982796819
Name:COUNTY OF CALHOUN COUNTY JUDGE
Entity Type:Organization
Organization Name:COUNTY OF CALHOUN COUNTY JUDGE
Other - Org Name:CALHOUN COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY JUDGE
Authorized Official - Prefix:
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:NUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-875-2273
Mailing Address - Street 1:PO BOX 121
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:AR
Mailing Address - Zip Code:71744-0121
Mailing Address - Country:US
Mailing Address - Phone:870-875-2273
Mailing Address - Fax:870-881-8989
Practice Address - Street 1:449 9TH STREET
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:AR
Practice Address - Zip Code:71744
Practice Address - Country:US
Practice Address - Phone:870-875-2273
Practice Address - Fax:870-881-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5473416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR189062715Medicaid
AR189062715Medicaid