County of Madison

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

135 Issued in AR

Legal business name

COUNTY OF MADISON

Doing business as

Madison County EMS

Practice address

110 Maintenance Drive
Huntsville, AR 72740-0456

Phone

(479) 738-2621

Fax

(724) 794-1633

NPI assigned

Dec 6, 2006

Last updated

Nov 6, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Keith Edmonds

Title

Director

Phone

(479) 738-2621

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MADISON COUNTY EMS Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572998400000",
    "number": "1841359106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "892 NEW CASTLE ROAD",
            "city": "SLIPPERY ROCK",
            "state": "PA",
            "postal_code": "160574228",
            "telephone_number": "800-280-5974",
            "fax_number": "724-794-1633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MAINTENANCE DRIVE",
            "city": "HUNTSVILLE",
            "state": "AR",
            "postal_code": "727400456",
            "telephone_number": "479-738-2621",
            "fax_number": "724-794-1633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF MADISON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2019-11-06",
        "status": "A",
        "authorized_official_last_name": "EDMONDS",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "479-738-2621"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "AR",
            "license": "135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103289715",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MADISON COUNTY EMS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MADISON COUNTY EMS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Cierra K Creek
• Rita I Cruz-Collins, LCSW
• Victoria Marie Deal, APRN, FNP-BC
• Gina Ann Dickey, APN

• Land Ambulance in Huntsville, AR
• Providers in Huntsville, AR by specialty
• Land Ambulance in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.