MEDICARE: ARKANSAS EMERGENCY TRANSPORT, LLC

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	341600000X	Ambulance	225	AR
2	341600000X	Ambulance	306	AR
3	341600000X	Ambulance	301	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48861	OTHER	AR	BCBS

General Provider Information

NPI Number	:	1124003850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARKANSAS EMERGENCY TRANSPORT, LLC

Provider Business Mailing Address
First Line	:	PO BOX 339
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72078-0339
Country	:	US
Telephone Number	:	501-982-5912
Fax Number	:	501-985-9912

Provider Business Practice Location Address
First Line	:	2003 MILITARY ROAD
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076
Country	:	US
Telephone Number	:	501-982-5912
Fax Number	:	501-985-9912

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROGER W HOSMAN
Credential	:
Telephone Number	:	501-982-5912

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	04/20/2008

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