Provider Demographics
NPI:1205994217
Name:KJ MEDICAL, LLC
Entity type:Organization
Organization Name:KJ MEDICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:504-833-3778
Mailing Address - Street 1:PO BOX 7824
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70010-7824
Mailing Address - Country:US
Mailing Address - Phone:504-833-3778
Mailing Address - Fax:504-833-3779
Practice Address - Street 1:3430 JEFFERSON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-2630
Practice Address - Country:US
Practice Address - Phone:504-833-3778
Practice Address - Fax:504-833-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3892569001332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA102468OtherUNITED HEALTHCARE
LAG9613OtherBLUE CROSS BLUE SHIELD
LA1476650Medicaid
LAH308654OtherMULTI PLAN
LAG9613OtherBLUE CROSS BLUE SHIELD