Provider Demographics
NPI:1336641851
Name:MJSC PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:MJSC PROFESSIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-341-9880
Mailing Address - Street 1:920 TAMPA ST
Mailing Address - Street 2:
Mailing Address - City:TALLULAH
Mailing Address - State:LA
Mailing Address - Zip Code:71282-5040
Mailing Address - Country:US
Mailing Address - Phone:318-341-9880
Mailing Address - Fax:
Practice Address - Street 1:920 TAMPA ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-5040
Practice Address - Country:US
Practice Address - Phone:318-341-9880
Practice Address - Fax:318-574-9917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker