MEDICARE: RIVERSIDE AMBULANCE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	0662	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104893676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE AMBULANCE INC

Provider Business Mailing Address
First Line	:	208 LIBERTY ST
Second Line	:
City	:	MARKED TREE
State	:	AR
Zip	:	72365-2207
Country	:	US
Telephone Number	:	870-358-3970
Fax Number	:	870-358-3974

Provider Business Practice Location Address
First Line	:	208 LIBERTY ST
Second Line	:
City	:	MARKED TREE
State	:	AR
Zip	:	72365-2207
Country	:	US
Telephone Number	:	870-358-3970
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	ROBERT BLAKE FOX
Credential	:
Telephone Number	:	870-358-3970

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	12/16/2025

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Directions to “RIVERSIDE AMBULANCE INC ” Practice Location

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