MEDICARE: JACK DAVIS

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)		VA

General Provider Information

NPI Number	:	1366316655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK DAVIS

Provider Business Mailing Address
First Line	:	15448 FEATHERCHASE DR
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-2666
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15448 FEATHERCHASE DR
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-2666
Country	:	US
Telephone Number	:	804-516-0033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2025
Last Update Date	:	10/01/2025

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Directions to “ JACK DAVIS ” Practice Location

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