Provider Demographics
NPI:1205094521
Name:JACKSON COUNTY TRANSPORTATION, INC.
Entity type:Organization
Organization Name:JACKSON COUNTY TRANSPORTATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:PEELER
Authorized Official - Suffix:
Authorized Official - Credentials:CCTM
Authorized Official - Phone:850-482-7433
Mailing Address - Street 1:PO BOX 1117
Mailing Address - Street 2:3988 OLD COTTONDALE ROAD
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-1117
Mailing Address - Country:US
Mailing Address - Phone:850-482-7433
Mailing Address - Fax:850-482-7592
Practice Address - Street 1:3988 OLD COTTONDALE RD
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-3612
Practice Address - Country:US
Practice Address - Phone:850-482-7433
Practice Address - Fax:850-482-7592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686611596Medicaid
FL686611598Medicaid