MEDICARE: JACOBS & WILSON RELIABLE TRANSPORTATION

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	:	1255295960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACOBS & WILSON RELIABLE TRANSPORTATION

Provider Business Mailing Address
First Line	:	22225 PAXTON AVE
Second Line	:
City	:	SAUK VILLAGE
State	:	IL
Zip	:	60411-5039
Country	:	US
Telephone Number	:	773-382-6558
Fax Number	:

Provider Business Practice Location Address
First Line	:	22225 PAXTON AVE
Second Line	:
City	:	SAUK VILLAGE
State	:	IL
Zip	:	60411-5039
Country	:	US
Telephone Number	:	773-382-6558
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROGER WILSON
Credential	:
Telephone Number	:	773-382-6558

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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