1013187244 NPI number — CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF KY INC

Table of content: (NPI 1013187244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013187244 NPI number — CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF KY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF KY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1013187244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
621 CARNEGIE DR
Provider Second Line Business Mailing Address:
STE 205
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92408-3536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-499-9495
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2807 TAYLORSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40205-3166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-479-9105
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KEENE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
NATIONAL DIRECTOR
Authorized Official Telephone Number:
909-915-2301

Provider Taxonomy Codes

  • Taxonomy code: 3416A0800X , with the licence number:  7001 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 55001630 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".