Jackson Parish Ambulance Service District

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

9110021 Issued in LA

Legal business name

JACKSON PARISH AMBULANCE SERVICE DISTRICT

Practice address

115 Watts St
Jonesboro, LA 71251-2053

Phone

(318) 259-2891

Fax

(318) 259-2099

NPI assigned

May 24, 2005

Last updated

Aug 30, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Tracy Brandon Wold, BS EMT-P

Title

EMS Director

Phone

(318) 259-2877

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283126400000",
    "number": "1124021092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 WATTS ST",
            "city": "JONESBORO",
            "state": "LA",
            "postal_code": "712512053",
            "telephone_number": "318-259-2891",
            "fax_number": "318-259-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 WATTS ST",
            "city": "JONESBORO",
            "state": "LA",
            "postal_code": "712512053",
            "telephone_number": "318-259-2891",
            "fax_number": "318-259-2099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON PARISH AMBULANCE SERVICE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2010-08-30",
        "status": "A",
        "authorized_official_last_name": "WOLD",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "BRANDON",
        "authorized_official_title_or_position": "EMS DIRECTOR",
        "authorized_official_telephone_number": "318-259-2877",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BS EMT-P"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "LA",
            "license": "9110021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "F4632",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1550426",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE (PALMETTO GBA)",
            "identifier": "P00634556",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Don Honaker, DPT
• Hope Hospice, LLC (ACG Hospice)
• Anita Gail Huckaby
• Tommy Hull
• Jackson Manor 1691 Tenant, LLC (Jackson Manor Nursing & Rehabilitation Center)
• Jackson Parish Hospital
• Jackson Parish Hospital
• Jackson Parish Hospital
• Jackson Parish Hospital
• Jackson Parish Hospital

• Land Ambulance in Jonesboro, LA
• Providers in Jonesboro, LA by specialty
• Land Ambulance in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.