Provider Demographics
NPI:1568743714
Name:KJM PROPERTIES, LLC
Entity Type:Organization
Organization Name:KJM PROPERTIES, LLC
Other - Org Name:DBA PIONEER PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-343-8848
Mailing Address - Street 1:2225 EAGLE SMT
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54482-8977
Mailing Address - Country:US
Mailing Address - Phone:715-343-8848
Mailing Address - Fax:715-343-8863
Practice Address - Street 1:1020 1ST ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-2631
Practice Address - Country:US
Practice Address - Phone:715-347-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization