Healthcare Provider Details

I. General information

NPI: 1366926057
Provider Name (Legal Business Name): JPM TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 STURGEON ROAD
LAWRENCEVILLE VA
23868
US

IV. Provider business mailing address

PO BOX 594
LAWRENCEVILLE VA
23868
US

V. Phone/Fax

Practice location:
  • Phone: 434-632-4513
  • Fax: 804-562-3015
Mailing address:
  • Phone: 434-632-4513
  • Fax: 804-562-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN PAUL MACKLIN SR.
Title or Position: OWNER/PROPRIETORSHIP
Credential:
Phone: 434-632-4513