MEDICARE: JACKSON PARISH AMBULANCE SERVICE DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	9110021	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00634556	OTHER	LA	RAILROAD MEDICARE (PALMETTO GBA)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F4632	OTHER	LA	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124021092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON PARISH AMBULANCE SERVICE DISTRICT

Provider Business Mailing Address
First Line	:	115 WATTS ST
Second Line	:
City	:	JONESBORO
State	:	LA
Zip	:	71251-2053
Country	:	US
Telephone Number	:	318-259-2891
Fax Number	:	318-259-2099

Provider Business Practice Location Address
First Line	:	115 WATTS ST
Second Line	:
City	:	JONESBORO
State	:	LA
Zip	:	71251-2053
Country	:	US
Telephone Number	:	318-259-2891
Fax Number	:	318-259-2099

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	MR. TRACY BRANDON WOLD
Credential	:	BS EMT-P
Telephone Number	:	318-259-2877

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/30/2010

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Directions to “JACKSON PARISH AMBULANCE SERVICE DISTRICT ” Practice Location

Language	Start Address	Practice Location

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