=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093109902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L&J TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2015
-----------------------------------------------------
Last Update Date | 03/28/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15728 DREXEL AVE
-----------------------------------------------------
City | DOLTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60419-2754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-849-4770
-----------------------------------------------------
Fax | 708-849-4771
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15728 DREXEL AVE
-----------------------------------------------------
City | DOLTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60419-2754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-849-4770
-----------------------------------------------------
Fax | 708-849-4771
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. JOCELYN WELLS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-849-4770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number | 7391MC
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 7391MC
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------