MEDICARE: JNK MEDICAL TRANSPORT 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	:	1407611908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JNK MEDICAL TRANSPORT LLC

Provider Business Mailing Address
First Line	:	463 LONG ACRE DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-8229
Country	:	US
Telephone Number	:	318-512-9452
Fax Number	:

Provider Business Practice Location Address
First Line	:	463 LONG ACRE DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-8229
Country	:	US
Telephone Number	:	318-379-4244
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CALISHA T FORTNER
Credential	:
Telephone Number	:	318-512-9452

Provider Enumeration Date	:	02/14/2024
Last Update Date	:	05/05/2026

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Directions to “JNK MEDICAL TRANSPORT LLC ” Practice Location

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