Healthcare Provider Details

I. General information

NPI: 1376606053
Provider Name (Legal Business Name): TRUMANN AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 JADEN COVE
TRUMANN AR
72472
US

IV. Provider business mailing address

PO BOX 81
TRUMANN AR
72472-0081
US

V. Phone/Fax

Practice location:
  • Phone: 870-483-6441
  • Fax: 870-483-7840
Mailing address:
  • Phone: 870-483-6441
  • Fax: 870-483-7840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0636
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0635
License Number StateAR

VIII. Authorized Official

Name: KIMBERLY DAWN WATKINS
Title or Position: PRESIDENT
Credential:
Phone: 870-483-6441