Provider Demographics
NPI:1699121608
Name:BJ TRANSPORTATION
Entity type:Organization
Organization Name:BJ TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:501-804-0318
Mailing Address - Street 1:12 PEACH TREE PL
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8516
Mailing Address - Country:US
Mailing Address - Phone:501-804-0318
Mailing Address - Fax:501-246-5246
Practice Address - Street 1:12 PEACH TREE PL
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-8516
Practice Address - Country:US
Practice Address - Phone:501-804-0318
Practice Address - Fax:501-246-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR910410720343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)