Healthcare Provider Details

I. General information

NPI: 1992708804
Provider Name (Legal Business Name): COUNTY OF LOGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E MAIN ST
PARIS AR
72855-3328
US

IV. Provider business mailing address

PO BOX 467
PARIS AR
72855-0467
US

V. Phone/Fax

Practice location:
  • Phone: 479-963-2723
  • Fax: 479-963-8355
Mailing address:
  • Phone: 479-963-2723
  • Fax: 479-963-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number730
License Number StateAR

VIII. Authorized Official

Name: MRS. BETTY A. FAIRBANKS
Title or Position: ADMINISTRATOR
Credential:
Phone: 479-963-2723