JDG Provider Services LLC

Primary specialty

Private VehicleTaxonomy code 347C00000X

Legal business name

JDG PROVIDER SERVICES LLC

Doing business as

JDG Non-Emergency Medical Transport

Practice address

1419 W 3Rd St
Tyler, TX 75701-2711

Phone

(903) 372-5024

NPI assigned

Mar 31, 2019

Last updated

Apr 3, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kingsley Obianwu

Title

Managing Member

Phone

(903) 372-5024

Specialties & licenses 1

Addresses

Other names 1

• JDG NON-EMERGENCY MEDICAL TRANSPORT Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554249600000",
    "number": "1427510452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1419 W 3RD ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012711",
            "telephone_number": "903-372-5024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1419 W 3RD ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757012711",
            "telephone_number": "903-372-5024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JDG PROVIDER SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-31",
        "last_updated": "2019-04-03",
        "status": "A",
        "authorized_official_last_name": "OBIANWU",
        "authorized_official_first_name": "KINGSLEY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "903-372-5024",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JDG NON-EMERGENCY MEDICAL TRANSPORT",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JDG NON-EMERGENCY MEDICAL TRANSPORT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Private Vehicle in Tyler, TX
• Providers in Tyler, TX by specialty
• Private Vehicle in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.