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General NPI Number Information
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NPI Number | 1124241013
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Entity Type | Organization
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Legal Business Name | CITY OF MARION
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 364 MILITARY RD
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City | MARION
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State | AR
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Zip | 72364-1734
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Country | US
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Telephone | 870-739-4127
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 83
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City | MARION
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State | AR
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Zip | 72364-0083
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Country | US
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Telephone | 807-739-4127
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Fax |
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Authorized Official
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Title or Position | CAPTAIN
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Name | MR. ROBERT DOUGLAS BLAKE
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Credential |
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Telephone | 901-409-2876
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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 | 693
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License Number State | AR
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