Provider Demographics
NPI:1053361295
Name:COLUMBIA COUNTY AMBULANCE SERVICE CO INC
Entity type:Organization
Organization Name:COLUMBIA COUNTY AMBULANCE SERVICE CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-234-7371
Mailing Address - Street 1:218 S PINE
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-3642
Mailing Address - Country:US
Mailing Address - Phone:870-234-7371
Mailing Address - Fax:870-234-2992
Practice Address - Street 1:218 S PINE
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3642
Practice Address - Country:US
Practice Address - Phone:870-234-7371
Practice Address - Fax:870-234-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5903416L0300X
AR5763416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47022Medicare ID - Type UnspecifiedAMBULANCE