Provider Demographics
NPI:1811915648
Name:JACKSON VOLUNTEER AMBULANCE
Entity type:Organization
Organization Name:JACKSON VOLUNTEER AMBULANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:SKARET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-847-4410
Mailing Address - Street 1:80 W ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1669
Mailing Address - Country:US
Mailing Address - Phone:507-847-5306
Mailing Address - Fax:
Practice Address - Street 1:305 SHERIDAN STR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-0242
Practice Address - Country:US
Practice Address - Phone:507-847-5306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0117341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN48400JAOtherBLUE CROSS BLUE SHIELD
MN48400JAOtherBLUE CROSS BLUE SHIELD