Provider Demographics
NPI:1013441864
Name:CITY TRANSPORTATION OF JAX,LLC
Entity Type:Organization
Organization Name:CITY TRANSPORTATION OF JAX,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALCIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-323-3333
Mailing Address - Street 1:5669 W BEAVER ST
Mailing Address - Street 2:1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-2858
Mailing Address - Country:US
Mailing Address - Phone:904-323-3333
Mailing Address - Fax:904-592-5330
Practice Address - Street 1:5669 W BEAVER ST
Practice Address - Street 2:1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-2858
Practice Address - Country:US
Practice Address - Phone:904-323-3333
Practice Address - Fax:904-592-5330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)