Healthcare Provider Details

I. General information

NPI: 1831206713
Provider Name (Legal Business Name): JACKSON EMERGENCY TRANSPORT SERVICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 COURT ST
GROVE HILL AL
36451-3228
US

IV. Provider business mailing address

PO BOX 2037
LAUREL MS
39442-2037
US

V. Phone/Fax

Practice location:
  • Phone: 601-422-7281
  • Fax:
Mailing address:
  • Phone: 601-422-7281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number552
License Number StateAL

VIII. Authorized Official

Name: MR. KEVIN SMITH
Title or Position: MANAGER
Credential: EMT-P
Phone: 614-422-7281