Provider Demographics
NPI:1326595869
Name:AJ TRANSPORT
Entity Type:Organization
Organization Name:AJ TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-755-1040
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:ID
Mailing Address - Zip Code:83839-0058
Mailing Address - Country:US
Mailing Address - Phone:208-755-1040
Mailing Address - Fax:
Practice Address - Street 1:510 S. 6TH ST.
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:ID
Practice Address - Zip Code:83850
Practice Address - Country:US
Practice Address - Phone:208-755-1040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPW213673B343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)