Provider Demographics
NPI:1891411443
Name:JCK MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:JCK MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:I
Authorized Official - Last Name:KORIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-267-8165
Mailing Address - Street 1:2550 W UNION HILLS DR STE 350-8934
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5163
Mailing Address - Country:US
Mailing Address - Phone:832-267-8165
Mailing Address - Fax:
Practice Address - Street 1:2550 W UNION HILLS DR STE 350-8934
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5163
Practice Address - Country:US
Practice Address - Phone:832-267-8165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ZUREY GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)