Active NPI
County of Logan
- Land Ambulance
- Paris, AR
National Provider Identifier
1992708804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- License
- 730
- Legal business name
- COUNTY OF LOGAN
- Practice address
- 310 E Main St
Paris, AR 72855-3328 - Phone
- (479) 963-2723
- Fax
- (479) 963-8355
- NPI assigned
- May 24, 2005
- Organization subpart
- Yes
- Parent organization
- COUNTY OF LOGAN
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Betty A. Fairbanks
- Title
- Administrator
- Phone
- (479) 963-2723
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 730 | AR | Primary |
Addresses
Primary practice location
310 E Main St
Paris, AR 72855-3328
Mailing address
PO Box 467
Paris, AR 72855-0467
Phone (479) 963-2723
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 590083475 | Other | AR | RAILROAD MEDICARE |
| 864525 | Other | AR | FEDERAL BLACK LUNG PROGRA |
| 103244715 | Medicaid | AR | |
| 47218 | Other | AR | BLUE CROSS BLUE SHIELD |
Other names 1
- Logan County Emergency Medical Services
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080124000118 | AR | Part B Supplier - Ambulance Service Supplier | 9133201536 | Practice locations: Paris, AR |
National Provider Directory
National Provider Directory- Part of
- County of Logan
Locations
310 E Main St
Paris, AR 72855
Phone (479) 963-2723
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1303257600000",
"number": "1992708804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 467",
"city": "PARIS",
"state": "AR",
"postal_code": "728550467",
"telephone_number": "479-963-2723",
"fax_number": "479-963-8355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 E MAIN ST",
"city": "PARIS",
"state": "AR",
"postal_code": "728553328",
"telephone_number": "479-963-2723",
"fax_number": "479-963-8355"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "COUNTY OF LOGAN",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "COUNTY OF LOGAN",
"enumeration_date": "2005-05-24",
"last_updated": "2011-04-20",
"status": "A",
"authorized_official_last_name": "FAIRBANKS",
"authorized_official_first_name": "BETTY",
"authorized_official_middle_name": "A.",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "479-963-2723",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "AR",
"license": "730",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "590083475",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL BLACK LUNG PROGRA",
"identifier": "864525",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103244715",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "47218",
"state": "AR"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Logan County Emergency Medical Services",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Paris, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.