Provider Demographics
NPI:1639372303
Name:BARTLETT-JACKSON AMBULANCE
Entity Type:Organization
Organization Name:BARTLETT-JACKSON AMBULANCE
Other - Org Name:BARTLETT-JACKSON EMERGENCY MED SRV
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAUDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:603-383-3651
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:GLEN
Mailing Address - State:NH
Mailing Address - Zip Code:03838
Mailing Address - Country:US
Mailing Address - Phone:603-383-3651
Mailing Address - Fax:603-383-3651
Practice Address - Street 1:ROUTE 302
Practice Address - Street 2:GLEN FIRE STATION
Practice Address - City:GLEN
Practice Address - State:NH
Practice Address - Zip Code:03838
Practice Address - Country:US
Practice Address - Phone:603-383-3651
Practice Address - Fax:603-383-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHS00006341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNH6261OtherMEDICARE PTAN
NHNH6261Medicare UPIN