Healthcare Provider Details

I. General information

NPI: 1285257105
Provider Name (Legal Business Name): CITY OF PERRVILLE CITY RECORDERS OFFICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 6TH ST
PERRYVILLE AR
72126
US

IV. Provider business mailing address

PO BOX 116
PERRYVILLE AR
72126-0116
US

V. Phone/Fax

Practice location:
  • Phone: 501-889-5016
  • Fax:
Mailing address:
  • Phone: 501-889-2862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: LEE TILLMAN STEWART
Title or Position: FIRE CHIEF
Credential:
Phone: 501-658-0548