MEDICARE: JACQUELYN ECHOLES

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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J171088004	OTHER	MO	TRANSPORTATION

General Provider Information

NPI Number	:	1427688571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN ECHOLES

Provider Business Mailing Address
First Line	:	5504 NATURAL BRIDGE APT 6 WEST
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63120
Country	:	US
Telephone Number	:	314-322-3277
Fax Number	:

Provider Business Practice Location Address
First Line	:	5504 NATURAL BRIDGE APT 6 WEST
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63120
Country	:	US
Telephone Number	:	314-322-3277
Fax Number	:

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

Provider Enumeration Date	:	01/16/2020
Last Update Date	:	01/16/2020

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Directions to “ JACQUELYN ECHOLES ” Practice Location

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