Provider Demographics
NPI:1346270725
Name:JACKSON COUNTY EMERGENCY SERVICES DISTRICT #1
Entity Type:Organization
Organization Name:JACKSON COUNTY EMERGENCY SERVICES DISTRICT #1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:VACLAVICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-284-3222
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:VANDERBILT
Mailing Address - State:TX
Mailing Address - Zip Code:77991-0455
Mailing Address - Country:US
Mailing Address - Phone:361-284-3222
Mailing Address - Fax:361-284-3572
Practice Address - Street 1:5955 FM 616
Practice Address - Street 2:
Practice Address - City:VANDERBILT
Practice Address - State:TX
Practice Address - Zip Code:77991
Practice Address - Country:US
Practice Address - Phone:361-284-3222
Practice Address - Fax:361-284-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX514825OtherUSED WITH INS. CLAIMS
TX514825OtherUSED WITH INS. CLAIMS