Provider Demographics
NPI:1750076402
Name:TRUCARE NON EMERGENCY MEDICAL TRANSPORTATION OF JAX
Entity type:Organization
Organization Name:TRUCARE NON EMERGENCY MEDICAL TRANSPORTATION OF JAX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-703-6968
Mailing Address - Street 1:7643 GATE PKWY STE 104-352
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3092
Mailing Address - Country:US
Mailing Address - Phone:844-205-2690
Mailing Address - Fax:
Practice Address - Street 1:5199 OAK BEND AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-6289
Practice Address - Country:US
Practice Address - Phone:904-703-6968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)