MEDICARE: JACOB TRANSPORTATION INC

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	344600000X	Taxi	20141323	AZ
2	343900000X	Non-emergency Medical Transport (VAN)	20141323	AZ

General Provider Information

NPI Number	:	1063709350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACOB TRANSPORTATION INC

Provider Business Mailing Address
First Line	:	5052 N 35 TH DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85019
Country	:	US
Telephone Number	:	602-866-7777
Fax Number	:	602-866-7786

Provider Business Practice Location Address
First Line	:	5052 N 35TH DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85019-2702
Country	:	US
Telephone Number	:	602-866-7777
Fax Number	:	602-866-7786

Authorized Official
Title or Position	:	OWNER/ PRESIDNET
Name	:	MR. JACOB YOUSIF ABUALOKUL JR.
Credential	:
Telephone Number	:	602-866-7777

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	07/07/2011

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Directions to “JACOB TRANSPORTATION INC ” Practice Location

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