Healthcare Provider Details

I. General information

NPI: 1679774855
Provider Name (Legal Business Name): BUFFALO ISLAND EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 NORTH EDMONDS
MONETTE AR
72447
US

IV. Provider business mailing address

PO BOX 73
MONETTE AR
72447-0073
US

V. Phone/Fax

Practice location:
  • Phone: 870-930-0333
  • Fax:
Mailing address:
  • Phone: 870-930-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0646
License Number StateAR

VIII. Authorized Official

Name: BOB BLANKENSHIP
Title or Position: DIRECTOR
Credential:
Phone: 870-486-5641