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General NPI Number Information
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NPI Number | 1124021092
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Entity Type | Organization
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Legal Business Name | JACKSON PARISH AMBULANCE SERVICE DISTRICT
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 115 WATTS ST
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City | JONESBORO
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State | LA
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Zip | 71251-2053
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Country | US
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Telephone | 318-259-2891
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Fax | 318-259-2099
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Provider Business Mailing Address
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Address Line | 115 WATTS ST
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City | JONESBORO
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State | LA
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Zip | 71251-2053
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Country | US
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Telephone | 318-259-2891
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Fax | 318-259-2099
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Authorized Official
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Title or Position | EMS DIRECTOR
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Name | MR. TRACY BRANDON WOLD
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Credential | BS EMT-P
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Telephone | 318-259-2877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 9110021
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License Number State | LA
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