Provider Demographics
NPI:1851685382
Name:JNA MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:JNA MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMENETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-474-3030
Mailing Address - Street 1:4041 UNIVERSITY DR
Mailing Address - Street 2:#450
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3414
Mailing Address - Country:US
Mailing Address - Phone:703-474-3030
Mailing Address - Fax:703-652-4215
Practice Address - Street 1:4041 UNIVERSITY DR
Practice Address - Street 2:#450
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3414
Practice Address - Country:US
Practice Address - Phone:703-474-3030
Practice Address - Fax:703-652-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA110954343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)