Provider Demographics
NPI:1598152746
Name:GENET MELESSE
Entity Type:Organization
Organization Name:GENET MELESSE
Other - Org Name:GJTRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENET
Authorized Official - Middle Name:
Authorized Official - Last Name:MELESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-203-5495
Mailing Address - Street 1:3612 GLASTONBURY TRL
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3468
Mailing Address - Country:US
Mailing Address - Phone:512-659-5990
Mailing Address - Fax:
Practice Address - Street 1:3612 GLASTONBURY TRL
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3468
Practice Address - Country:US
Practice Address - Phone:512-659-5990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)