Provider Demographics
NPI:1588297766
Name:LBJ TRANSPORTATION
Entity type:Organization
Organization Name:LBJ TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATHERN
Authorized Official - Middle Name:BARNARD
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-507-8966
Mailing Address - Street 1:45772 JONES WAY
Mailing Address - Street 2:
Mailing Address - City:CALLAHAN
Mailing Address - State:FL
Mailing Address - Zip Code:32011-8821
Mailing Address - Country:US
Mailing Address - Phone:904-507-8966
Mailing Address - Fax:
Practice Address - Street 1:45772 JONES WAY
Practice Address - Street 2:
Practice Address - City:CALLAHAN
Practice Address - State:FL
Practice Address - Zip Code:32011-8821
Practice Address - Country:US
Practice Address - Phone:904-507-8966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)