Provider Demographics
NPI:1871738781
Name:JACKSON TRANSPORTATION GROUP LLC
Entity type:Organization
Organization Name:JACKSON TRANSPORTATION GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-288-2091
Mailing Address - Street 1:287 ELAM RD
Mailing Address - Street 2:
Mailing Address - City:RAY
Mailing Address - State:OH
Mailing Address - Zip Code:45672-9628
Mailing Address - Country:US
Mailing Address - Phone:740-288-2091
Mailing Address - Fax:740-286-6732
Practice Address - Street 1:287 ELAM RD
Practice Address - Street 2:
Practice Address - City:RAY
Practice Address - State:OH
Practice Address - Zip Code:45672-9628
Practice Address - Country:US
Practice Address - Phone:740-288-2091
Practice Address - Fax:740-286-6732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)