Provider Demographics
NPI:1396515292
Name:BLUE JAY TAXI LLC
Entity type:Organization
Organization Name:BLUE JAY TAXI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-921-4110
Mailing Address - Street 1:W7148 VON BESSER DR
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-8426
Mailing Address - Country:US
Mailing Address - Phone:715-921-4110
Mailing Address - Fax:
Practice Address - Street 1:W7148 VON BESSER DR
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-8426
Practice Address - Country:US
Practice Address - Phone:715-921-4110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi