MEDICARE: BIANNA JONES

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	:	1720624943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANNA JONES

Provider Business Mailing Address
First Line	:	4637 W ADAMS ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-4632
Country	:	US
Telephone Number	:	312-409-3579
Fax Number	:

Provider Business Practice Location Address
First Line	:	4637 W ADAMS ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-4632
Country	:	US
Telephone Number	:	312-409-3579
Fax Number	:

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

Provider Enumeration Date	:	11/22/2019
Last Update Date	:	11/22/2019

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