MEDICARE: CITY OF JACKSONVILLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	040281	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730188673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF JACKSONVILLE

Provider Business Mailing Address
First Line	:	320 CHURCH AVE SE
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-2651
Country	:	US
Telephone Number	:	256-435-7611
Fax Number	:	256-435-4103

Provider Business Practice Location Address
First Line	:	506 CHINABEE AVE SE
Second Line	:
City	:	JACKSONVILLE
State	:	AL
Zip	:	36265-2881
Country	:	US
Telephone Number	:	256-435-7611
Fax Number	:	256-435-4103

Authorized Official
Title or Position	:	MAYOR
Name	:	MR. JOHNNY L SMITH
Credential	:
Telephone Number	:	256-435-7611

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	02/09/2011

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Directions to “CITY OF JACKSONVILLE ” Practice Location

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