Healthcare Provider Details

I. General information

NPI: 1740358910
Provider Name (Legal Business Name): CJ SYSTEMS AVIATION GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 ALLEGHENY COUNTY AIRPORT
WEST MIFFLIN PA
15122-2674
US

IV. Provider business mailing address

275 CURRY HOLLOW RD SUITE G-300
PITTSBURGH PA
15236-4631
US

V. Phone/Fax

Practice location:
  • Phone: 412-466-2500
  • Fax:
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 Number080707
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number6604829
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number6604829
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number028
License Number StateSD

VIII. Authorized Official

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