=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962415232
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOODRUFF COUNTY AMBULANCE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2006
-----------------------------------------------------
Last Update Date | 10/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 NORTH EDMONDS AVE
-----------------------------------------------------
City | MCCRORY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-731-2072
-----------------------------------------------------
Fax | 870-731-0032
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 402
-----------------------------------------------------
City | MCCRORY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72101-0402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-731-2072
-----------------------------------------------------
Fax | 870-731-0032
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. JUDY CAROL GARNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 870-731-2072
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------