Provider Demographics
NPI:1245787563
Name:JACOB TRANSPORTATION SERVICES, LLC
Entity Type:Organization
Organization Name:JACOB TRANSPORTATION SERVICES, LLC
Other - Org Name:EXECUTIVE LAS VEGAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:JIMMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-949-5384
Mailing Address - Street 1:3950 W TOMPKINS AVENUE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NY
Mailing Address - Zip Code:98103
Mailing Address - Country:US
Mailing Address - Phone:702-429-3672
Mailing Address - Fax:
Practice Address - Street 1:3950 TOMPKINS AVENUE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NY
Practice Address - Zip Code:98103
Practice Address - Country:US
Practice Address - Phone:702-429-3672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi