City of Pea Ridge
Organization Active NPI Land Ambulance · Pea Ridge, AR
NPI 1407875461 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1407875461
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 0147 (AR)
- Legal business name
- CITY OF PEA RIDGE
- Practice address
- 293 South Curtis Ave
Pea Ridge, AR 72751-0010 - Phone
- (479) 451-1111
- Fax
- (479) 451-1681
- NPI assigned
- Jul 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Jamie Wayne Baggett
- Title
- Fire Chief
- Phone
- (479) 451-1111
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081007000518 | AR | Part B Supplier - Ambulance Service Supplier | 3274601091 | Practice locations: Pea Ridge, AR |
National Provider Directory
Locations
293 S Curtis Ave
Pea Ridge, AR 72751
Phone (479) 451-1105
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | AR | ||
| Land Ambulance | 3416L0300X | 0147 | AR | Yes |
Addresses
Primary practice location
293 South Curtis Ave
Pea Ridge, AR 72751-0010
Mailing address
P.O. Box 10
Pea Ridge, AR 72751-0010
Phone (479) 451-1111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121930715 | Medicaid | AR | |
| 47322 | Other | AR | BCBS |
Other names
- Pea Ridge Fire Department
Other providers in Pea Ridge, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.