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General NPI Number Information
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NPI Number | 1699121608
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Entity Type | Organization
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Legal Business Name | BJ TRANSPORTATION
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 12 PEACH TREE PL
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City | LITTLE ROCK
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State | AR
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Zip | 72204-8516
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Country | US
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Telephone | 501-804-0318
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Fax | 501-246-5246
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Provider Business Mailing Address
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Address Line | 12 PEACH TREE PL
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City | LITTLE ROCK
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State | AR
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Zip | 72204-8516
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Country | US
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Telephone | 501-804-0318
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Fax | 501-246-5246
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. JOHN RUSSELL SR.
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Credential |
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Telephone | 501-804-0318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 910410720
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License Number State | AR
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