Healthcare Provider Details

I. General information

NPI: 1215397625
Provider Name (Legal Business Name): JASON RUSSELL EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 REID STREET, ATTN: MCHJ-CLQ-C MADIGAN ARMY MEDICAL CENTER
TACOMA WA
98431-1100
US

IV. Provider business mailing address

9040 REID STREET, ATTN: MCHJ-CLQ-C MADIGAN ARMY MEDICAL CENTER
TACOMA WA
98431-1100
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1110
  • Fax: 877-874-1031
Mailing address:
  • Phone: 253-968-1110
  • Fax: 877-874-1031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: