Provider Demographics
NPI:1063709350
Name:JACOB TRANSPORTATION INC
Entity type:Organization
Organization Name:JACOB TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDNET
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:YOUSIF
Authorized Official - Last Name:ABUALOKUL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:602-866-7777
Mailing Address - Street 1:5052 N 35 TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019
Mailing Address - Country:US
Mailing Address - Phone:602-866-7777
Mailing Address - Fax:602-866-7786
Practice Address - Street 1:5052 N 35TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-2702
Practice Address - Country:US
Practice Address - Phone:602-866-7777
Practice Address - Fax:602-866-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20141323344600000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi