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NPI Code Detail

MEDICARE: JAEDA JORDAN LLC

MEDICARE: JAEDA JORDAN 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
1343900000XNon-emergency Medical Transport (VAN)

General Provider Information

NPI Number : 1396529632
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAEDA JORDAN LLC
Provider Business Mailing Address
First Line : 4549 CARNATION CT
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-3578
Country : US
Telephone Number : 704-615-2153
Fax Number :
Provider Business Practice Location Address
First Line : 4549 CARNATION CT
Second Line :
City : CHARLOTTE
State : NC
Zip : 28269-3578
Country : US
Telephone Number : 704-615-2153
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JAEDA JORDAN
Credential :
Telephone Number : 704-615-2153
Provider Enumeration Date : 08/18/2023
Last Update Date : 12/30/2023

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