=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417733205
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S&J TRANSPORTATION SERVICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2023
-----------------------------------------------------
Last Update Date | 09/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4125 DUDLEYS GRANT DR APT G
-----------------------------------------------------
City | WINTERVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28590-9072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-345-4627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4125 DUDLEYS GRANT DR APT G
-----------------------------------------------------
City | WINTERVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28590-9072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-345-4627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | TANYA BARRETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-345-4627
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 342000000X
-----------------------------------------------------
Taxonomy Name | Transportation Network Company
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------