Provider Demographics
NPI:1033657127
Name:CAPTAIN JACK'S TAXICAB AND TRANSPORTATION SERVICE
Entity Type:Organization
Organization Name:CAPTAIN JACK'S TAXICAB AND TRANSPORTATION SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:225-400-2464
Mailing Address - Street 1:8555 THELMA ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807-4658
Mailing Address - Country:US
Mailing Address - Phone:225-400-2464
Mailing Address - Fax:225-775-8143
Practice Address - Street 1:8555 THELMA ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-4658
Practice Address - Country:US
Practice Address - Phone:225-400-2464
Practice Address - Fax:225-775-8143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)