MEDICARE: CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF FL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416A0800X	Air Ambulance	0451	FL

General Provider Information

NPI Number	:	1629235270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF FL INC

Provider Business Mailing Address
First Line	:	621 CARNEGIE DR STE 206
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3536
Country	:	US
Telephone Number	:	800-499-9495
Fax Number	:

Provider Business Practice Location Address
First Line	:	3792 E US HIGHWAY 90
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-1406
Country	:	US
Telephone Number	:	386-755-7128
Fax Number	:

Authorized Official
Title or Position	:	NATIONAL DIRECTOR
Name	:	MARK KEENE
Credential	:
Telephone Number	:	909-915-2301

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	05/21/2008

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