MEDICARE: CITY TRANSPORTATION OF JAX,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1013441864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY TRANSPORTATION OF JAX,LLC

Provider Business Mailing Address
First Line	:	5669 W BEAVER ST
Second Line	:	1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-2858
Country	:	US
Telephone Number	:	904-323-3333
Fax Number	:	904-592-5330

Provider Business Practice Location Address
First Line	:	5669 W BEAVER ST
Second Line	:	1
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-2858
Country	:	US
Telephone Number	:	904-323-3333
Fax Number	:	904-592-5330

Authorized Official
Title or Position	:	CEO
Name	:	HAL ALCIDE
Credential	:
Telephone Number	:	904-323-3333

Provider Enumeration Date	:	04/19/2017
Last Update Date	:	04/19/2017

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