MEDICARE: JBL GROUP ENTERPRISE LIMITED

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	:	1366892580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JBL GROUP ENTERPRISE LIMITED

Provider Business Mailing Address
First Line	:	1223 W 87TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-4042
Country	:	US
Telephone Number	:	773-580-0053
Fax Number	:	708-223-7898

Provider Business Practice Location Address
First Line	:	1223 W 87TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-4042
Country	:	US
Telephone Number	:	773-580-0053
Fax Number	:	708-223-7898

Authorized Official
Title or Position	:	OWNER
Name	:	MS. GERTHA JUANITA WELLS
Credential	:
Telephone Number	:	773-580-0053

Provider Enumeration Date	:	06/18/2016
Last Update Date	:	06/18/2016

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