Healthcare Provider Details

I. General information

NPI: 1306333067
Provider Name (Legal Business Name): KJ MEDICAL MOBILE TRANSPORT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MILL CREEK RD APT 407
JACKSONVILLE FL
32211-4479
US

IV. Provider business mailing address

PO BOX 8499
JACKSONVILLE FL
32239-0499
US

V. Phone/Fax

Practice location:
  • Phone: 904-887-9978
  • Fax:
Mailing address:
  • Phone: 904-887-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER MITCHELL
Title or Position: PRESIDENT
Credential:
Phone: 904-887-9978