Provider Demographics
NPI:1417409475
Name:J&J AMBULETTE SERVICE, LLC
Entity Type:Organization
Organization Name:J&J AMBULETTE SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-502-0543
Mailing Address - Street 1:12266 PRINCE GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:DISPUTANTA
Mailing Address - State:VA
Mailing Address - Zip Code:23842-4404
Mailing Address - Country:US
Mailing Address - Phone:804-861-1266
Mailing Address - Fax:804-861-6221
Practice Address - Street 1:12266 PRINCE GEORGE DR
Practice Address - Street 2:
Practice Address - City:DISPUTANTA
Practice Address - State:VA
Practice Address - Zip Code:23842-4404
Practice Address - Country:US
Practice Address - Phone:804-861-1266
Practice Address - Fax:804-861-6221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA83343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA41LX067181063100OtherLEXINGTON INSURANCE COMPANY