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General NPI Number Information
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NPI Number | 1851685382
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Entity Type | Organization
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Legal Business Name | JNA MEDICAL TRANSPORT, LLC
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 4041 UNIVERSITY DR #450
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City | FAIRFAX
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State | VA
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Zip | 22030-3414
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Country | US
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Telephone | 703-474-3030
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Fax | 703-652-4215
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Provider Business Mailing Address
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Address Line | 4041 UNIVERSITY DR #450
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City | FAIRFAX
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State | VA
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Zip | 22030-3414
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Country | US
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Telephone | 703-474-3030
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Fax | 703-652-4215
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RANDY KAMENETSKY
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Credential |
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Telephone | 703-474-3030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 110954
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License Number State | VA
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