Healthcare Provider Details

I. General information

NPI: 1063512051
Provider Name (Legal Business Name): SOUTHARK EMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 N MAIN ST
HAMBURG AR
71646-2722
US

IV. Provider business mailing address

PO BOX 127
HAMBURG AR
71646-0127
US

V. Phone/Fax

Practice location:
  • Phone: 870-853-4800
  • Fax: 870-881-8989
Mailing address:
  • Phone: 870-853-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number491
License Number StateAR

VIII. Authorized Official

Name: MR. SHANNON SHAVER
Title or Position: PRES.
Credential:
Phone: 870-853-4800