Healthcare Provider Details

I. General information

NPI: 1154463081
Provider Name (Legal Business Name): CHICKASAW AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BUCKEYE STREET
FREDERICKSBURG IA
50630
US

IV. Provider business mailing address

121 BUCKEYE STREET
FREDERICKSBURG IA
50630
US

V. Phone/Fax

Practice location:
  • Phone: 563-237-6414
  • Fax: 563-237-6414
Mailing address:
  • Phone: 563-237-6414
  • Fax: 563-237-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: JAMES J COOK
Title or Position: PRESIDENT
Credential:
Phone: 563-237-6414