Healthcare Provider Details

I. General information

NPI: 1962478180
Provider Name (Legal Business Name): LITTLE ROCK AMBULANCE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W 8TH ST
LITTLE ROCK AR
72201-3918
US

IV. Provider business mailing address

PO BOX 2452
LITTLE ROCK AR
72203-2452
US

V. Phone/Fax

Practice location:
  • Phone: 501-301-1400
  • Fax:
Mailing address:
  • Phone: 501-301-1400
  • Fax: 501-301-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number334
License Number StateAR

VIII. Authorized Official

Name: LARMON VAN WINKLE
Title or Position: FINANCIAL DIRECTOR
Credential:
Phone: 501-301-1400