Provider Demographics
NPI:1124792981
Name:JACKSON TRANSPORTATION LLC
Entity type:Organization
Organization Name:JACKSON TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:540-229-2019
Mailing Address - Street 1:2165 COTTONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-4183
Mailing Address - Country:US
Mailing Address - Phone:540-727-7698
Mailing Address - Fax:540-727-7698
Practice Address - Street 1:2165 COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-4183
Practice Address - Country:US
Practice Address - Phone:540-727-7698
Practice Address - Fax:540-727-7698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)