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General NPI Number Information
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NPI Number | 1104893676
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Entity Type | Organization
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Legal Business Name | RIVERSIDE AMBULANCE INC
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Dates
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Enumeration Date | 03/03/2006
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 208 LIBERTY ST
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City | MARKED TREE
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State | AR
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Zip | 72365-2207
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Country | US
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Telephone | 870-358-3970
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Fax |
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Provider Business Mailing Address
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Address Line | 208 LIBERTY ST
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City | MARKED TREE
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State | AR
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Zip | 72365-2207
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Country | US
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Telephone | 870-358-3970
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Fax | 870-358-3974
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | ROBERT BLAKE FOX
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Credential |
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Telephone | 870-358-3970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 0662
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License Number State | AR
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