Provider Demographics
NPI:1952946378
Name:MJM DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:MJM DIAGNOSTICS LLC
Other - Org Name:NEW FRONTIER MOBILE DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-787-1555
Mailing Address - Street 1:1301 OAK ST STE 713
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-2913
Mailing Address - Country:US
Mailing Address - Phone:833-763-6363
Mailing Address - Fax:
Practice Address - Street 1:1301 OAK ST STE 713
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64106-2913
Practice Address - Country:US
Practice Address - Phone:833-763-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier