Provider Demographics
NPI:1699420711
Name:J&K MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:J&K MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-407-9119
Mailing Address - Street 1:2124 BRIANS LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6331
Mailing Address - Country:US
Mailing Address - Phone:757-407-9119
Mailing Address - Fax:757-539-6582
Practice Address - Street 1:2124 BRIANS LN
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6331
Practice Address - Country:US
Practice Address - Phone:757-407-9119
Practice Address - Fax:757-539-6582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)