Organization
JACKSON COMMUNITY AMBULANCE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DALE J BERRY (PRESIDENT/CEO)
(734) 477-6262
Entity
Organization
Contact information
Practice address
1200 STATE CIR, ANN ARBOR, MI 48108-1691
(734) 971-4733
(734) 477-6786
Mailing address
1200 STATE CIR, ANN ARBOR, MI 48108-1691
(734) 971-4733
(734) 477-6786
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
381013
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183319100
—
MI
01
—
590H10003
BLUE CROSS BLUE SHIELD
MI
Enumeration date
06/29/2006
Last updated
02/02/2017
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