Jackson County Court House Executive
Organization Active NPI Land Ambulance · Gainesboro, TN
NPI 1861496341 · NPPES record last updated Jun 15, 2021
Key facts
- NPI
- 1861496341
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- EMS0000004401 (TN)
- Legal business name
- JACKSON COUNTY COURT HOUSE EXECUTIVE
- Practice address
- 316 N. Murray Street
Gainesboro, TN 38562 - Phone
- (931) 268-2556
- Fax
- (931) 268-3044
- NPI assigned
- Jun 13, 2005
- Organization subpart
- No
Authorized official
- Name
- Jeffery Keith Bean
- Title
- Director
- Phone
- (931) 268-2556
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0951350 | Jackson County Ambulance Service | Certificate of waiver | Sep 15, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120312000724 | TN | Part B Supplier - Ambulance Service Supplier | 8729247655 | Practice locations: Gainesboro, TN |
National Provider Directory
Locations
316 N Murray St
Gainesboro, TN 38562
Phone (615) 793-7440
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | EMS0000004401 | TN | Yes |
Addresses
Primary practice location
316 N. Murray Street
Gainesboro, TN 38562
Mailing address
PO Box 9150
Paducah, KY 42002-9150
Phone (270) 744-9600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3525078 | Medicaid | TN |
Other names
- Jackson County Ambulance Service
Other providers in Gainesboro, TN
- Gaw Family Dentistry
- Brad Thomas Gaw
- Ted W. Gaw
- Grandkin Caregivers LLC
- Candi Denise Holland
- Jackson County Medical Center LLC
- Teneal Faye Jenkins
- Travis Jones
- Jennifer Keith
- Kristi Malena Lafever
All providers in Gainesboro, TN · Land Ambulance in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2021. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.