Healthcare Provider Details

I. General information

NPI: 1487420022
Provider Name (Legal Business Name): MALACHI CJ MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 01/01/2024
Certification Date: 01/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19327 BRITTANY CREEK DR
SPRING TX
77388-3117
US

IV. Provider business mailing address

19327 BRITTANY CREEK DR
SPRING TX
77388-3117
US

V. Phone/Fax

Practice location:
  • Phone: 571-354-9178
  • Fax:
Mailing address:
  • Phone: 571-354-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH M BAIDOO
Title or Position: OWNER
Credential:
Phone: 571-354-9178