Provider Demographics
NPI:1366673717
Name:JETFLY TRANSPORTATION,LLC
Entity Type:Organization
Organization Name:JETFLY TRANSPORTATION,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MORTON
Authorized Official - Last Name:CLARKSTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:504-330-7727
Mailing Address - Street 1:3308 TULANE AVE
Mailing Address - Street 2:STE 322
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-7100
Mailing Address - Country:US
Mailing Address - Phone:504-472-8448
Mailing Address - Fax:504-822-4427
Practice Address - Street 1:3308 TULANE AVE
Practice Address - Street 2:STE 322
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7100
Practice Address - Country:US
Practice Address - Phone:504-472-8448
Practice Address - Fax:504-822-4427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA810426343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA9999999Medicaid