=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710508262
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILO FIRE DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2020
-----------------------------------------------------
Last Update Date | 05/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2166 HIGHWAY 189 N
-----------------------------------------------------
City | HAMBURG
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71646-8854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-853-7427
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 311 ASHLEY 496 RD
-----------------------------------------------------
City | HAMBURG
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-853-7427
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF
-----------------------------------------------------
Name | GARY PETERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 870-853-7427
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------