Provider Demographics
NPI:1295033975
Name:JIBRICO TRANSPORTATION LLC
Entity Type:Organization
Organization Name:JIBRICO TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SILAS
Authorized Official - Last Name:COTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-809-0042
Mailing Address - Street 1:7725 W MCDOWELL RD
Mailing Address - Street 2:APT# 3018
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85035-6471
Mailing Address - Country:US
Mailing Address - Phone:602-809-0042
Mailing Address - Fax:
Practice Address - Street 1:7725 W MCDOWELL RD
Practice Address - Street 2:APT# 3018
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-6471
Practice Address - Country:US
Practice Address - Phone:602-809-0042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD04488408347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle