MEDICARE: PROMED AMBULANCE,INC.

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	583/804	AR

General Provider Information

NPI Number	:	1417057480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMED AMBULANCE,INC.

Provider Business Mailing Address
First Line	:	PO BOX 11330
Second Line	:	1152 STRONG HWY
City	:	EL DORADO
State	:	AR
Zip	:	71730-0033
Country	:	US
Telephone Number	:	870-875-2273
Fax Number	:	870-881-8989

Provider Business Practice Location Address
First Line	:	1152 STRONG HWY
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-9636
Country	:	US
Telephone Number	:	870-875-2273
Fax Number	:	870-881-8989

Authorized Official
Title or Position	:	PRES/CEO
Name	:	MR. KEN KELLEY
Credential	:
Telephone Number	:	870-875-2273

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/22/2020

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