MEDICARE: JJ MOBILITY

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)	343900000X

General Provider Information

NPI Number	:	1629412911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JJ MOBILITY

Provider Business Mailing Address
First Line	:	W8660 174TH AVE
Second Line	:
City	:	HAGER CITY
State	:	WI
Zip	:	54014-8140
Country	:	US
Telephone Number	:	651-380-8632
Fax Number	:

Provider Business Practice Location Address
First Line	:	W8660 174TH AVE
Second Line	:
City	:	HAGER CITY
State	:	WI
Zip	:	54014-8140
Country	:	US
Telephone Number	:	651-380-8632
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. JEANETTE JEAN JABLONSKE
Credential	:
Telephone Number	:	651-380-8632

Provider Enumeration Date	:	04/17/2013
Last Update Date	:	04/17/2013

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