# J K AMBULANCE

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

## Provider details

- **NPI number:** 1972690451
- **Authorized official:** MR. PERRY SHOVE (PRESIDENT)
- **Authorized official phone:** (208) 276-3789

## Contact information

- **Practice address:** NO STREET ADDRESS N 6TH ST, KENDRICK, ID 83537
- **Practice address phone:** (208) 289-3381
- **Practice address fax:** (208) 289-5050
- **Mailing address:** PO BOX 182, KENDRICK, ID 83537-0182
- **Mailing address phone:** (208) 289-3381
- **Mailing address fax:** (208) 289-5050

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 341600000X | Ambulance | 7216 | ID | Yes |

## Other

- **Enumeration date:** 10/06/2006
- **Last updated:** 06/28/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 002514200 | — | ID |