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General NPI Number Information
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NPI Number | 1972690451
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Entity Type | Organization
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Legal Business Name | J K AMBULANCE
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 06/28/2012
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Provider Practice Location Address
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Address Line | NO STREET ADDRESS N 6TH ST
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City | KENDRICK
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State | ID
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Zip | 83537
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Country | US
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Telephone | 208-289-3381
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Fax | 208-289-5050
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Provider Business Mailing Address
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Address Line | PO BOX 182
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City | KENDRICK
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State | ID
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Zip | 83537-0182
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Country | US
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Telephone | 208-289-3381
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Fax | 208-289-5050
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PERRY SHOVE
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Credential |
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Telephone | 208-276-3789
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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 | 7216
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License Number State | ID
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