Provider Demographics
NPI:1699877001
Name:WILBURN FIRE & RESCUE DEPT.
Entity type:Organization
Organization Name:WILBURN FIRE & RESCUE DEPT.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:N
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-206-7247
Mailing Address - Street 1:P.O. BOX 57
Mailing Address - Street 2:
Mailing Address - City:WILBURN
Mailing Address - State:AR
Mailing Address - Zip Code:72179-0057
Mailing Address - Country:US
Mailing Address - Phone:501-206-7247
Mailing Address - Fax:501-728-3212
Practice Address - Street 1:5 TAYLOR LANE
Practice Address - Street 2:
Practice Address - City:WILBURN
Practice Address - State:AR
Practice Address - Zip Code:72179
Practice Address - Country:US
Practice Address - Phone:501-728-3212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR02833416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47084Medicare ID - Type Unspecified