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General NPI Number Information
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NPI Number | 1851755136
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Entity Type | Organization
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Legal Business Name | BLUE SHIELD AMBULANCE SERVICE LLC
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 07/01/2016
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Provider Practice Location Address
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Address Line | 941 ALLEN RD
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City | NASHVILLE
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State | TN
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Zip | 37214-3598
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Country | US
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Telephone | 888-857-3667
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Fax |
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Provider Business Mailing Address
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Address Line | 443 DONELSON PIKE STE 103
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City | NASHVILLE
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State | TN
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Zip | 37214-3559
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Country | US
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Telephone | 888-857-3667
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MAHMOUD JBOOR
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Credential |
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Telephone | 888-857-3667
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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 | 191419
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License Number State | TN
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