MEDICARE: CITY OF JACKSONVILLE

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	358	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	:	1902895055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF JACKSONVILLE

Provider Business Mailing Address
First Line	:	PO BOX 305
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72078-0305
Country	:	US
Telephone Number	:	501-500-3028
Fax Number	:	501-241-2882

Provider Business Practice Location Address
First Line	:	900 N REDMOND RD
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-3623
Country	:	US
Telephone Number	:	501-985-1252
Fax Number	:

Authorized Official
Title or Position	:	AR SPECIALIST
Name	:	NIKKI WILMOTH
Credential	:
Telephone Number	:	501-500-3028

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	01/15/2026

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Directions to “CITY OF JACKSONVILLE ” Practice Location

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