=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285335786
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CJT EXPRESS TRANSPORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2023
-----------------------------------------------------
Last Update Date | 03/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3599 N CANAL RD
-----------------------------------------------------
City | MACCLENNY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32063-4830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-444-9622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 33
-----------------------------------------------------
City | MACCLENNY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32063-0033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-444-9622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | NIESHA STEVENS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-444-9622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------