Provider Demographics
NPI:1104376078
Name:JET KARRIERS TRANSPORTATION
Entity Type:Organization
Organization Name:JET KARRIERS TRANSPORTATION
Other - Org Name:KARL ALLEN TRUMBLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:TRUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-720-6410
Mailing Address - Street 1:97 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1256
Mailing Address - Country:US
Mailing Address - Phone:315-720-6410
Mailing Address - Fax:315-331-5232
Practice Address - Street 1:97 EAST AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1256
Practice Address - Country:US
Practice Address - Phone:315-720-6410
Practice Address - Fax:315-331-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03219321344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03219321Medicaid