Healthcare Provider Details

I. General information

NPI: 1871521542
Provider Name (Legal Business Name): JACKSON COMMUNITY AMBULANCE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 STATE CIR
ANN ARBOR MI
48108-1691
US

IV. Provider business mailing address

1200 STATE CIR
ANN ARBOR MI
48108-1691
US

V. Phone/Fax

Practice location:
  • Phone: 734-971-4733
  • Fax: 734-477-6786
Mailing address:
  • Phone: 734-971-4733
  • Fax: 734-477-6786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number381013
License Number StateMI

VIII. Authorized Official

Name: MR. DALE J BERRY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 734-477-6262