Healthcare Provider Details

I. General information

NPI: 1235200015
Provider Name (Legal Business Name): GEMS AMBULANCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 HOUSTON AVE
PERRYVILLE AR
72126-9451
US

IV. Provider business mailing address

PO BOX 715
PERRYVILLE AR
72126-0715
US

V. Phone/Fax

Practice location:
  • Phone: 501-889-5749
  • Fax: 501-889-2212
Mailing address:
  • Phone: 501-889-5749
  • Fax: 501-889-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number872
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number871
License Number StateAR

VIII. Authorized Official

Name: DON E GALBRAITH
Title or Position: NREMTI OWNER
Credential:
Phone: 501-889-5749