Jackson Forest Emergency Ambulance Service

Primary specialty

AmbulanceTaxonomy code 341600000X

Legal business name

JACKSON FOREST EMERGENCY AMBULANCE SERVICE

Doing business as

Jackson Forest Ambulance District

Practice address

211 W Lima St
Forest, OH 45843-1129

Phone

(419) 273-2713

Fax

(419) 273-7108

NPI assigned

Dec 20, 2006

Last updated

Jun 12, 2024By 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

Charity Anne Holland

Title

Fiscal Officer

Phone

(419) 957-2781

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Jackson Forest Ambulance District Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

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": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1467516948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21727",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441210727",
            "telephone_number": "440-605-9117",
            "fax_number": "440-442-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 W LIMA ST",
            "city": "FOREST",
            "state": "OH",
            "postal_code": "458431129",
            "telephone_number": "419-273-2713",
            "fax_number": "419-273-7108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON FOREST EMERGENCY AMBULANCE SERVICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "CHARITY",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "FISCAL OFFICER",
        "authorized_official_telephone_number": "419-957-2781"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0310569",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590006210",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Forest Ambulance District",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Briana Digby
• Bobbijo I Drumm, PTA
• Mark Edward Fenzl, D.O.
• Jennifer Marie Frey, CNP
• Kathy Garman
• Jessika King
• Kelly Melroy
• Kaisha Runion, QBHS
• Michelle Stone, OTA.05198
• Deborah Sue Thompson

• Ambulance in Forest, OH
• Providers in Forest, OH by specialty
• Ambulance in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.