Healthcare Provider Details

I. General information

NPI: 1053896407
Provider Name (Legal Business Name): TUCKERMAN VOLUNTEER AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MAIN
TUCKERMAN AR
72473-9362
US

IV. Provider business mailing address

PO BOX 641880
OMAHA NE
68164-7880
US

V. Phone/Fax

Practice location:
  • Phone: 870-349-5212
  • Fax:
Mailing address:
  • Phone: 402-991-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: BARBARA A VAUGHN
Title or Position: AGENT- OFFICIAL
Credential:
Phone: 402-991-7866