MEDICARE: JAYREESE TRANSPORTATION SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1003047937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAYREESE TRANSPORTATION SERVICE

Provider Business Mailing Address
First Line	:	7600 ROOSEVELT RD
Second Line	:
City	:	FOREST PARK
State	:	IL
Zip	:	60130-2273
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7600 ROOSEVELT RD
Second Line	:
City	:	FOREST PARK
State	:	IL
Zip	:	60130-2273
Country	:	US
Telephone Number	:	773-957-8862
Fax Number	:	708-771-0017

Authorized Official
Title or Position	:	MANGER
Name	:	BERNARD JAMES
Credential	:
Telephone Number	:	773-957-8862

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	07/27/2009

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Directions to “JAYREESE TRANSPORTATION SERVICE ” Practice Location

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