Healthcare Provider Details

I. General information

NPI: 1023870722
Provider Name (Legal Business Name): BJKM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6113 EDLYNNE RD
BALTIMORE MD
21239-1927
US

IV. Provider business mailing address

6113 EDLYNNE RD
BALTIMORE MD
21239-1927
US

V. Phone/Fax

Practice location:
  • Phone: 443-763-0573
  • Fax: 443-759-4223
Mailing address:
  • Phone: 443-763-0573
  • Fax: 443-759-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: NICHELLE MACKEY
Title or Position: MANAGER
Credential:
Phone: 443-763-0573