=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114063583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEVADA COUNTY AMBULANCE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 11/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 864 E MAIN ST
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71857-3803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-887-2339
-----------------------------------------------------
Fax | 870-887-6260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 267
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71857-0267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-887-2339
-----------------------------------------------------
Fax | 870-887-6260
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. NICK HIBBS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 870-887-2339
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 0505
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 0595
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------