=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821867813
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JET J ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/01/2024
-----------------------------------------------------
Last Update Date | 01/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6607 WINDY HILLS LN
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77493-2923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-305-1066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6607 WINDY HILLS LN
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77493-2923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-305-1066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | SEGUN JAYEOLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-305-1066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------