MEDICARE: JERRON GEDDIS

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	343800000X	Secured Medical Transport (VAN)	G32042068362	IL
2	343900000X	Non-emergency Medical Transport (VAN)	G32042068362	IL
3	347C00000X	Private Vehicle	G32042068362	IL
4	347E00000X	Transportation Broker	G32042068362	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073938528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRON GEDDIS

Provider Business Mailing Address
First Line	:	5421 S MAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-6052
Country	:	US
Telephone Number	:	773-354-5421
Fax Number	:

Provider Business Practice Location Address
First Line	:	5421 S MAY ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-6052
Country	:	US
Telephone Number	:	773-354-5421
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2014
Last Update Date	:	02/20/2014

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Directions to “ JERRON GEDDIS ” Practice Location

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