Provider Demographics
NPI:1043385883
Name:JACKSON COUNTY AUDITOR
Entity Type:Organization
Organization Name:JACKSON COUNTY AUDITOR
Other - Org Name:JACKSON COUNTY AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASHER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:812-523-7501
Mailing Address - Street 1:209 S ARMSTRONG ST
Mailing Address - Street 2:
Mailing Address - City:CROTHERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47229-1601
Mailing Address - Country:US
Mailing Address - Phone:812-793-8141
Mailing Address - Fax:812-793-2319
Practice Address - Street 1:616 W BROWN ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2970
Practice Address - Country:US
Practice Address - Phone:812-523-7501
Practice Address - Fax:812-522-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN03913416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN987600Medicare ID - Type UnspecifiedMEDICARE PROVICER NUMBER