Provider Demographics
NPI:1215696026
Name:PROVISION TRANSPORTATION LLC
Entity type:Organization
Organization Name:PROVISION TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:FEEBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-212-1624
Mailing Address - Street 1:21081 W 224TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-7562
Mailing Address - Country:US
Mailing Address - Phone:620-212-5082
Mailing Address - Fax:
Practice Address - Street 1:21081 W 224TH ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-7562
Practice Address - Country:US
Practice Address - Phone:620-212-5082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)