Healthcare Provider Details

I. General information

NPI: 1710956743
Provider Name (Legal Business Name): JASON RANDALL TRUITT HS2/EMT-B/IDHS/LSM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USCG HQ COMDT (CG-1122) 2100 SECOND ST SW
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

USCG HQ COMDT (CG-1122) 2100 SECOND ST SW
WASHINGTON DC
20593-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-475-5909
  • Fax: 202-475-5909
Mailing address:
  • Phone: 202-475-5181
  • Fax: 202-472-5909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: