Provider Demographics
NPI:1679603260
Name:JEFFERSON COUNTY SERVICE ORGANIZATION
Entity type:Organization
Organization Name:JEFFERSON COUNTY SERVICE ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-863-2637
Mailing Address - Street 1:P.O. BOX 212
Mailing Address - Street 2:610 DELAWARE
Mailing Address - City:OSKALOOSA
Mailing Address - State:KS
Mailing Address - Zip Code:66066-0212
Mailing Address - Country:US
Mailing Address - Phone:785-863-2637
Mailing Address - Fax:785-863-3064
Practice Address - Street 1:612 DELAWARE
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:KS
Practice Address - Zip Code:66066-0212
Practice Address - Country:US
Practice Address - Phone:785-863-2637
Practice Address - Fax:785-863-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)