MEDICARE: JACOB AND SONS

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)	115002055	TN

General Provider Information

NPI Number	:	1497132310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACOB AND SONS

Provider Business Mailing Address
First Line	:	6366 E VILLAGE GROVE PL
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-1460
Country	:	US
Telephone Number	:	901-282-7817
Fax Number	:

Provider Business Practice Location Address
First Line	:	6366 E VILLAGE GROVE PL
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-1460
Country	:	US
Telephone Number	:	901-282-7817
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACOB LEMASSI
Credential	:
Telephone Number	:	901-282-7817

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	04/29/2015

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