MEDICARE: JETFLY TRANSPORTATION,LLC

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)	A810426	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366673717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JETFLY TRANSPORTATION,LLC

Provider Business Mailing Address
First Line	:	3308 TULANE AVE
Second Line	:	STE 322
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-7100
Country	:	US
Telephone Number	:	504-472-8448
Fax Number	:	504-822-4427

Provider Business Practice Location Address
First Line	:	3308 TULANE AVE
Second Line	:	STE 322
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-7100
Country	:	US
Telephone Number	:	504-472-8448
Fax Number	:	504-822-4427

Authorized Official
Title or Position	:	CEO
Name	:	MR. JAMES MORTON CLARKSTON JR.
Credential	:
Telephone Number	:	504-330-7727

Provider Enumeration Date	:	08/03/2009
Last Update Date	:	08/03/2009

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