Healthcare Provider Details

I. General information

NPI: 1972690451
Provider Name (Legal Business Name): J K AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NO STREET ADDRESS N 6TH ST
KENDRICK ID
83537
US

IV. Provider business mailing address

PO BOX 182
KENDRICK ID
83537-0182
US

V. Phone/Fax

Practice location:
  • Phone: 208-289-3381
  • Fax: 208-289-5050
Mailing address:
  • Phone: 208-289-3381
  • Fax: 208-289-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number7216
License Number StateID

VIII. Authorized Official

Name: MR. PERRY SHOVE
Title or Position: PRESIDENT
Credential:
Phone: 208-276-3789