City of Jacksonville
Organization Active NPI Land Ambulance · Jacksonville, AL
NPI 1730188673 · NPPES record last updated Feb 9, 2011
Key facts
- NPI
- 1730188673
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 040281 (AL)
- Legal business name
- CITY OF JACKSONVILLE
- Practice address
- 506 Chinabee Ave SE
Jacksonville, AL 36265-2881 - Phone
- (256) 435-7611
- Fax
- (256) 435-4103
- NPI assigned
- Jul 20, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Johnny L Smith
- Title
- Mayor
- Phone
- (256) 435-7611
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120511000417 | AL | Part B Supplier - Ambulance Service Supplier | 1456514371 | Practice locations: Jacksonville, AL |
National Provider Directory
Locations
911 Public Safety Dr
Jacksonville, AL 36265
Phone (256) 435-2310
320 Church Ave SE
Jacksonville, AL 36265
Phone (205) 435-7611
506 Chinabee Ave SE
Jacksonville, AL 36265
Phone (256) 435-2310
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 040281 | AL | Yes |
Addresses
Primary practice location
506 Chinabee Ave SE
Jacksonville, AL 36265-2881
Mailing address
320 Church Ave SE
Jacksonville, AL 36265-2651
Phone (256) 435-7611
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200008103 | Medicaid | AL |
Other providers in Jacksonville, AL
- Ginger L Caudell
- Anmarie Chandler
- Chelsea Nicole Chandler
- David Glenn Chandler
- Susan Dianne Cheatwood
- Kyle Andrew Clapper
- Briyana Clark
- Christopher Marvin Clark
- Dakota B Clark
- Julie Clark
All providers in Jacksonville, AL · Land Ambulance in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.