Provider Demographics
NPI:1114338951
Name:PRECIOUS JEWELS TRANSPORT CO
Entity Type:Organization
Organization Name:PRECIOUS JEWELS TRANSPORT CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-513-4710
Mailing Address - Street 1:1112 W 111TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4512
Mailing Address - Country:US
Mailing Address - Phone:312-513-4710
Mailing Address - Fax:773-779-7764
Practice Address - Street 1:1112 W 111TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4512
Practice Address - Country:US
Practice Address - Phone:312-513-4710
Practice Address - Fax:773-779-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILS530 0444 6664343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)