Provider Demographics
NPI:1215327648
Name:JORDAN VALLEY EMERGENCY MEDICAL SERVICE AUTHORITY
Entity type:Organization
Organization Name:JORDAN VALLEY EMERGENCY MEDICAL SERVICE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-536-7881
Mailing Address - Street 1:PO BOX 920
Mailing Address - Street 2:
Mailing Address - City:EAST JORDAN
Mailing Address - State:MI
Mailing Address - Zip Code:49727-0920
Mailing Address - Country:US
Mailing Address - Phone:231-536-7881
Mailing Address - Fax:231-308-6440
Practice Address - Street 1:555 MAPLE ST
Practice Address - Street 2:
Practice Address - City:EAST JORDAN
Practice Address - State:MI
Practice Address - Zip Code:49727-9778
Practice Address - Country:US
Practice Address - Phone:231-536-7881
Practice Address - Fax:231-308-6440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance