Jackson Community Ambulance Inc.

Primary specialty

AmbulanceTaxonomy code 341600000X

License

381013 Issued in MI

Legal business name

JACKSON COMMUNITY AMBULANCE INC.

Practice address

1200 State Cir
Ann Arbor, MI 48108-1691

Phone

(734) 971-4733

Fax

(734) 477-6786

NPI assigned

Jun 29, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Dale J Berry

Title

President/Ceo

Phone

(734) 477-6262

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

Locations

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485993600000",
    "number": "1871521542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 STATE CIR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081691",
            "telephone_number": "734-971-4733",
            "fax_number": "734-477-6786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 STATE CIR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081691",
            "telephone_number": "734-971-4733",
            "fax_number": "734-477-6786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON COMMUNITY AMBULANCE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2017-02-02",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "734-477-6262",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "MI",
            "license": "381013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "183319100",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "590H10003",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayla Marie Jabs, PA-C
• Thaddeus Jabzanka
• Mary Ellen Jachec, M.D.
• Cynthia Ann Jachym, RN
• Jamie George Jackish, M.D.
• Jackson Counseling Agency
• Brianna Jackson
• Hope Tiffany Jackson, M.D.
• Jasmyne Amanda Jackson, MD
• Jeffrey Frank Jackson, CRNA

• Ambulance in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Ambulance in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2017; 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.

Verify at the official NPI Registry.