Provider Demographics
NPI:1952071052
Name:TRANSPORTATION BY JACKSON
Entity Type:Organization
Organization Name:TRANSPORTATION BY JACKSON
Other - Org Name:TRANSPORTATION BY JACKSON
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER / TRANSPORTATION BY JACKSON
Authorized Official - Prefix:
Authorized Official - First Name:FELICEON
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-215-0382
Mailing Address - Street 1:223 FRIEDRICHS RD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-3808
Mailing Address - Country:US
Mailing Address - Phone:504-215-0382
Mailing Address - Fax:
Practice Address - Street 1:223 FRIEDRICHS RD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-3808
Practice Address - Country:US
Practice Address - Phone:504-215-0382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)