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General NPI Number Information
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NPI Number | 1811915648
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Entity Type | Organization
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Legal Business Name | JACKSON VOLUNTEER AMBULANCE
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 305 SHERIDAN STR
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City | JACKSON
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State | MN
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Zip | 56143-0242
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Country | US
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Telephone | 507-847-5306
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Fax |
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Provider Business Mailing Address
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Address Line | 80 W ASHLEY ST
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City | JACKSON
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State | MN
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Zip | 56143-1669
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Country | US
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Telephone | 507-847-5306
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Fax |
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Authorized Official
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Title or Position | CITY ADMINISTRATOR
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Name | MATT SKARET
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Credential |
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Telephone | 507-847-4410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 0117
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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