MEDICARE: MEDIC ONE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	626	AR
2	3416L0300X	Land Ambulance	629	AR
3	3416L0300X	Land Ambulance	627	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336114131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDIC ONE, LLC

Provider Business Mailing Address
First Line	:	6007 DALTON FARMER DR
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72404-8895
Country	:	US
Telephone Number	:	870-972-0708
Fax Number	:	870-972-5787

Provider Business Practice Location Address
First Line	:	6007 DALTON FARMER DR
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72404-8895
Country	:	US
Telephone Number	:	870-972-0708
Fax Number	:	870-972-5787

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KIM M MANN
Credential	:
Telephone Number	:	870-972-8484

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	02/16/2026

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Directions to “MEDIC ONE, LLC ” Practice Location

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