Provider Demographics
NPI:1487321055
Name:JACK, BILLY JOICE
Entity type:Individual
Prefix:MRS
First Name:BILLY
Middle Name:JOICE
Last Name:JACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 MILL CREEK DR # 4902
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-4131
Mailing Address - Country:US
Mailing Address - Phone:281-683-5061
Mailing Address - Fax:
Practice Address - Street 1:4902 MILL CREEK DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-4131
Practice Address - Country:US
Practice Address - Phone:281-683-5061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)