# JDG PROVIDER SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** JDG NON-EMERGENCY MEDICAL TRANSPORT
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427510452
- **Authorized official:** MR. KINGSLEY OBIANWU (MANAGING MEMBER)
- **Authorized official phone:** (903) 372-5024

## Contact information

- **Practice address:** 1419 W 3RD ST, TYLER, TX 75701-2711
- **Practice address phone:** (903) 372-5024
- **Mailing address:** 1419 W 3RD ST, TYLER, TX 75701-2711
- **Mailing address phone:** (903) 372-5024

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 347C00000X | Private Vehicle | — | NULL | Yes |

## Other

- **Enumeration date:** 03/31/2019
- **Last updated:** 04/03/2019