Healthcare Provider Details

I. General information

NPI: 1316217268
Provider Name (Legal Business Name): LANDJET,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SALEM ST SUITE 14
WOBURN MA
01801-2097
US

IV. Provider business mailing address

215 SALEM ST SUITE 14
WOBURN MA
01801-2070
US

V. Phone/Fax

Practice location:
  • Phone: 781-281-0780
  • Fax: 781-281-0780
Mailing address:
  • Phone: 781-281-0780
  • Fax: 781-281-0780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number213
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number214
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number215
License Number StateMA

VIII. Authorized Official

Name: SCOTT W. PAYNE
Title or Position: PRESIDENT
Credential:
Phone: 781-853-3133