=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659789972
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JBS TRANSPORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2014
-----------------------------------------------------
Last Update Date | 07/30/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 599 INDUSTRIAL DR
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-4207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-340-2580
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1683
-----------------------------------------------------
City | NOBLESVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46061-1683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-340-2580
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. BRIAN SANDYS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-340-2580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | 427800
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------