Provider Demographics
NPI:1851755136
Name:BLUE SHIELD AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:BLUE SHIELD AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:JBOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-857-3667
Mailing Address - Street 1:443 DONELSON PIKE
Mailing Address - Street 2:STE 103
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3559
Mailing Address - Country:US
Mailing Address - Phone:888-857-3667
Mailing Address - Fax:
Practice Address - Street 1:941 ALLEN RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3598
Practice Address - Country:US
Practice Address - Phone:888-857-3667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1914193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport