Provider Demographics
NPI:1790780971
Name:CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF FLORIDA, INC.
Entity Type:Organization
Organization Name:CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF FLORIDA, 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 1:3792 E US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-1406
Practice Address - Country:US
Practice Address - Phone:386-755-7128
Practice Address - Fax:386-755-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3683416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5080Medicare ID - Type Unspecified
FLE4090Medicare ID - Type Unspecified