Provider Demographics
NPI:1831196823
Name:BJA INCORPORATED
Entity type:Organization
Organization Name:BJA INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-532-3757
Mailing Address - Street 1:99 ROSEWOOD DR STE 245
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-4537
Mailing Address - Country:US
Mailing Address - Phone:978-536-7400
Mailing Address - Fax:
Practice Address - Street 1:598 NORTHLAKE BLVD STE 1040
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:407-834-1023
Practice Address - Fax:866-830-4248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC4910261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2200OtherBLUE CROSS & BLUE SHIELD
FL3237168001OtherCIGNA
FL7441067OtherAETNA PPO AND POS
FL198180OtherSTAYWELL HMO
FL198180OtherWELLCARE HMO
FL2239829OtherAETNA HMO
FL=========OtherUNITED HEALTH CARE
FL=========OtherSOUTHCARE HEALTH INS.
FLV2200OtherBLUE CROSS & BLUE SHIELD
FL=========OtherTRICARE & CHAMPUS
FL=========OtherSOUTHCARE HEALTH INS.