Active NPI
Jackson Volunteer Ambulance
Doing business as Jackson Ambulance Service
- Land Ambulance
- Jackson, MN
National Provider Identifier
1811915648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- Legal business name
- JACKSON VOLUNTEER AMBULANCE
- Doing business as
- Jackson Ambulance Service
- Practice address
- 305 Sheridan STR
Jackson, MN 56143-0242 - Phone
- (507) 847-5306
- NPI assigned
- Jul 18, 2006
- Last updated
- Oct 31, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Matt Skaret
- Title
- City Administrator
- Phone
- (507) 847-4410
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | 0117 | MN | |
| Land Ambulance | 3416L0300X | Primary |
Addresses
Primary practice location
305 Sheridan STR
Jackson, MN 56143-0242
Mailing address
80 W Ashley St
Jackson, MN 56143-1669
Phone (507) 847-5306
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 48400JA | Other | MN | BLUE CROSS BLUE SHIELD |
Other names 1
- Jackson Ambulance Service
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041204000302 | MN | Part B Supplier - Ambulance Service Supplier | 7911963640 | Practice locations: Jackson, MN |
National Provider Directory
National Provider Directory- Tax ID family
- City of Jackson
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1698710400000",
"number": "1811915648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 W ASHLEY ST",
"city": "JACKSON",
"state": "MN",
"postal_code": "561431669",
"telephone_number": "507-847-5306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 SHERIDAN STR",
"city": "JACKSON",
"state": "MN",
"postal_code": "561430242",
"telephone_number": "507-847-5306"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JACKSON VOLUNTEER AMBULANCE",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-18",
"last_updated": "2023-10-31",
"certification_date": "2023-10-31",
"status": "A",
"authorized_official_last_name": "SKARET",
"authorized_official_first_name": "MATT",
"authorized_official_title_or_position": "CITY ADMINISTRATOR",
"authorized_official_telephone_number": "507-847-4410"
},
"taxonomies": [
{
"code": "341600000X",
"taxonomy_group": "",
"desc": "Ambulance",
"state": "MN",
"license": "0117",
"primary": false
},
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "48400JA",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Jackson Ambulance Service",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Jackson, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.