Healthcare Provider Details

I. General information

NPI: 1992700173
Provider Name (Legal Business Name): CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF KENTUCKY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BYPASS RD
PIKEVILLE KY
41501-1689
US

IV. Provider business mailing address

275 CURRY HOLLOW RD STE G300
PITTSBURGH PA
15236-4631
US

V. Phone/Fax

Practice location:
  • Phone: 606-218-4602
  • Fax: 606-218-4609
Mailing address:
  • Phone: 412-653-2185
  • Fax: 412-653-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number7013
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number1207
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number7010
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1611
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number3010
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number7019
License Number StateKY

VIII. Authorized Official

Name: MARK KEENE
Title or Position: NATIONAL DIRECTOR
Credential:
Phone: 909-915-2301