MEDICARE: EMERGENCY AMBULANCE SERVICE OF ARKANSAS, 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	146L00000X	Paramedic	407	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

General Provider Information

NPI Number	:	1710978978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERGENCY AMBULANCE SERVICE OF ARKANSAS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 5099
Second Line	:
City	:	PINE BLUFF
State	:	AR
Zip	:	71611-5099
Country	:	US
Telephone Number	:	870-536-0734
Fax Number	:	870-534-8378

Provider Business Practice Location Address
First Line	:	1653 S HIGHWAY 65 82
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-1661
Country	:	US
Telephone Number	:	870-536-0734
Fax Number	:	870-534-8378

Authorized Official
Title or Position	:	CFO
Name	:	MR. LEN PALMISANO
Credential	:
Telephone Number	:	870-536-0734

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	07/21/2008

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