Provider Demographics
NPI:1174569206
Name:CITY OF DUMAS
Entity type:Organization
Organization Name:CITY OF DUMAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:EMS DIRECTOR EMT
Authorized Official - Phone:870-382-1131
Mailing Address - Street 1:P.O. BOX 157
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639
Mailing Address - Country:US
Mailing Address - Phone:870-382-1131
Mailing Address - Fax:870-382-5667
Practice Address - Street 1:149 E WATERMAN ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639
Practice Address - Country:US
Practice Address - Phone:870-382-1131
Practice Address - Fax:870-382-5667
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF DUMAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-20
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR440341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102083715Medicaid
AR47111OtherBCBS
AR590013281OtherRAILROAD MEDICARE
AR47111Medicare ID - Type Unspecified