MEDICARE: J3 RELIABLE 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	:	1639925761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J3 RELIABLE TRANSPORT LLC

Provider Business Mailing Address
First Line	:	20136 HWY 18
Second Line	:
City	:	HERMANVILLE
State	:	MS
Zip	:	39086
Country	:	US
Telephone Number	:	601-617-5653
Fax Number	:

Provider Business Practice Location Address
First Line	:	20136 HWY 18
Second Line	:
City	:	HERMANVILLE
State	:	MS
Zip	:	39086
Country	:	US
Telephone Number	:	601-617-5653
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. RONALDLYN JEANEICE SHOULDERS-JONES
Credential	:
Telephone Number	:	601-617-5653

Provider Enumeration Date	:	04/29/2024
Last Update Date	:	04/29/2024

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