Provider Demographics
NPI:1972690451
Name:J K AMBULANCE
Entity type:Organization
Organization Name:J K AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-276-3789
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:KENDRICK
Mailing Address - State:ID
Mailing Address - Zip Code:83537-0182
Mailing Address - Country:US
Mailing Address - Phone:208-289-3381
Mailing Address - Fax:208-289-5050
Practice Address - Street 1:NO STREET ADDRESS N 6TH ST
Practice Address - Street 2:
Practice Address - City:KENDRICK
Practice Address - State:ID
Practice Address - Zip Code:83537
Practice Address - Country:US
Practice Address - Phone:208-289-3381
Practice Address - Fax:208-289-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7216341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002514200Medicaid
ID002514200Medicaid