# JACKSON COMMUNITY AMBULANCE INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871521542
- **Authorized official:** MR. DALE J BERRY (PRESIDENT/CEO)
- **Authorized official phone:** (734) 477-6262

## Contact information

- **Practice address:** 1200 STATE CIR, ANN ARBOR, MI 48108-1691
- **Practice address phone:** (734) 971-4733
- **Practice address fax:** (734) 477-6786
- **Mailing address:** 1200 STATE CIR, ANN ARBOR, MI 48108-1691
- **Mailing address phone:** (734) 971-4733
- **Mailing address fax:** (734) 477-6786

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | 381013 | MI | Yes |

## Other

- **Enumeration date:** 06/29/2006
- **Last updated:** 02/02/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 183319100 | — | MI |
| 01 | — | 590H10003 | BLUE CROSS BLUE SHIELD | MI |