Healthcare Provider Details

I. General information

NPI: 1861454506
Provider Name (Legal Business Name): CITY OF FAIRFIELD BAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LITTLE ROCK DRIVE
FAIRFIELD BAY AR
72088-1271
US

IV. Provider business mailing address

PO BOX 1271
FAIRFIELD BAY AR
72088-1271
US

V. Phone/Fax

Practice location:
  • Phone: 501-884-6006
  • Fax:
Mailing address:
  • Phone: 501-884-6006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number248
License Number StateAR

VIII. Authorized Official

Name: MR. ROBERT CHALOUPEK
Title or Position: EMS CAPTAIN
Credential: EMT
Phone: 501-884-6006