Healthcare Provider Details

I. General information

NPI: 1750323309
Provider Name (Legal Business Name): ARKANSAS EXCELLENT TRANSPORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 EAST MAIN
WANUT RIDGE AR
72476
US

IV. Provider business mailing address

PO BOX 16 401 EAST MAIN
WALNUT RIDGE AR
72476
US

V. Phone/Fax

Practice location:
  • Phone: 870-886-6400
  • Fax: 870-886-6401
Mailing address:
  • Phone: 870-886-6400
  • Fax: 870-886-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number0625
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number625
License Number StateAR

VIII. Authorized Official

Name: MRS. LORRAINE A JONES
Title or Position: BILLING MANGER
Credential:
Phone: 870-886-6400