Provider Demographics
NPI:1114471380
Name:CJ MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:CJ MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:HACKWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-656-9888
Mailing Address - Street 1:2311 W CONE BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4042
Mailing Address - Country:US
Mailing Address - Phone:336-656-9888
Mailing Address - Fax:336-419-0260
Practice Address - Street 1:2311 W CONE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4042
Practice Address - Country:US
Practice Address - Phone:336-656-9888
Practice Address - Fax:336-419-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40332856Medicaid