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General NPI Number Information
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NPI Number | 1871521542
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Entity Type | Organization
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Legal Business Name | JACKSON COMMUNITY AMBULANCE INC.
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 1200 STATE CIR
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City | ANN ARBOR
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State | MI
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Zip | 48108-1691
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Country | US
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Telephone | 734-971-4733
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Fax | 734-477-6786
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Provider Business Mailing Address
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Address Line | 1200 STATE CIR
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City | ANN ARBOR
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State | MI
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Zip | 48108-1691
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Country | US
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Telephone | 734-971-4733
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Fax | 734-477-6786
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. DALE J BERRY
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Credential |
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Telephone | 734-477-6262
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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 | 381013
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License Number State | MI
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