Riverside Ambulance Inc

Key facts

NPI

1104893676

Entity type

Organization (NPI type 2)

Primary specialty

Land Ambulance 3416L0300X

License

0662 (AR)

Legal business name

RIVERSIDE AMBULANCE INC

Practice address

208 Liberty St
Marked Tree, AR 72365-2207

Phone

(870) 358-3970

NPI assigned

Mar 3, 2006

Organization subpart

No

Authorized official

Name

Robert Blake Fox

Title

President/Owner

Phone

(870) 358-3970

Medicare participation

Medicare fee-for-service enrollment

Enrolled in AR

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 16, 2025.

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765843200000",
    "number": "1104893676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 LIBERTY ST",
            "city": "MARKED TREE",
            "state": "AR",
            "postal_code": "723652207",
            "telephone_number": "870-358-3970",
            "fax_number": "870-358-3974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 LIBERTY ST",
            "city": "MARKED TREE",
            "state": "AR",
            "postal_code": "723652207",
            "telephone_number": "870-358-3970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE AMBULANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-03",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "BLAKE",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "870-358-3970"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "AR",
            "license": "0662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126017715",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "riversideambulance3359@gmail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "riversideambulance3359@gmail.com",
            "address_1": "208 Liberty St",
            "city": "Marked Tree",
            "state": "AR",
            "country_code": "US",
            "postal_code": "723652207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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All providers in Marked Tree, AR · Land Ambulance in Arkansas