Provider Demographics
NPI:1477723609
Name:CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF KY
Entity Type:Organization
Organization Name:CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF KY
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 1:621 CARNEGIE DR
Mailing Address - Street 2:STE 205
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3536
Mailing Address - Country:US
Mailing Address - Phone:800-499-9495
Mailing Address - Fax:
Practice Address - Street 1:229 35TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2023
Practice Address - Country:US
Practice Address - Phone:909-915-2303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF KY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-04
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY70193416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY55001507Medicaid
KY8055201Medicare PIN