Healthcare Provider Details

I. General information

NPI: 1780064774
Provider Name (Legal Business Name): J MAE TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 N WHITNEY ST APT 404
ST AUGUSTINE FL
32084
US

IV. Provider business mailing address

28 N WHITNEY ST APT 404
ST AUGUSTINE FL
32084
US

V. Phone/Fax

Practice location:
  • Phone: 386-225-0504
  • Fax: 866-760-4381
Mailing address:
  • Phone: 386-225-0504
  • Fax: 866-760-4381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. JONATHAN BROWN
Title or Position: OWNER, MANAGER, OPERATOR
Credential:
Phone: 386-225-0504