MEDICARE: JACKSON 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	:	1619926458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON TRANSPORTATION

Provider Business Mailing Address
First Line	:	20255 MACON LN
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-3825
Country	:	US
Telephone Number	:	941-255-0642
Fax Number	:

Provider Business Practice Location Address
First Line	:	20255 MACON LN
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-3825
Country	:	US
Telephone Number	:	941-255-0642
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PATRICK FERDINAND JACKSON
Credential	:
Telephone Number	:	941-255-0642

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	08/22/2020

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