Provider Demographics
NPI:1053896407
Name:TUCKERMAN VOLUNTEER AMBULANCE SERVICE
Entity type:Organization
Organization Name:TUCKERMAN VOLUNTEER AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT- OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-991-7866
Mailing Address - Street 1:PO BOX 641880
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-7880
Mailing Address - Country:US
Mailing Address - Phone:402-991-7866
Mailing Address - Fax:
Practice Address - Street 1:201 W MAIN
Practice Address - Street 2:
Practice Address - City:TUCKERMAN
Practice Address - State:AR
Practice Address - Zip Code:72473-9362
Practice Address - Country:US
Practice Address - Phone:870-349-5212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport