Healthcare Provider Details

I. General information

NPI: 1336641851
Provider Name (Legal Business Name): MJSC PROFESSIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 TAMPA ST
TALLULAH LA
71282-5040
US

IV. Provider business mailing address

1818 HIGHWAY 134
MONROE LA
71203-6774
US

V. Phone/Fax

Practice location:
  • Phone: 318-703-8288
  • Fax: 800-613-4669
Mailing address:
  • Phone: 318-703-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MARKITA WASHINGTON
Title or Position: OWNER
Credential:
Phone: 318-703-8288