Provider Demographics
NPI:1992700173
Name:CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF KENTUCKY, INC.
Entity type:Organization
Organization Name:CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF KENTUCKY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-915-2301
Mailing Address - Street 1:275 CURRY HOLLOW RD
Mailing Address - Street 2:STE G300
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4631
Mailing Address - Country:US
Mailing Address - Phone:412-653-2185
Mailing Address - Fax:412-653-6050
Practice Address - Street 1:911 BYPASS RD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1689
Practice Address - Country:US
Practice Address - Phone:606-218-4602
Practice Address - Fax:606-218-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY70133416A0800X
KY70193416A0800X
VA12073416A0800X
KY70103416A0800X
KY16113416L0300X
KY30103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010008808Medicaid
KY55000871Medicaid
WV8010002000Medicaid