MEDICARE: K.J MEDICAL TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1295413565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K.J MEDICAL TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	5243 CIDER MILL LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1817
Country	:	US
Telephone Number	:	317-970-9869
Fax Number	:

Provider Business Practice Location Address
First Line	:	5243 CIDER MILL LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1817
Country	:	US
Telephone Number	:	317-970-9869
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENYA CANNON
Credential	:
Telephone Number	:	317-970-9869

Provider Enumeration Date	:	07/07/2023
Last Update Date	:	07/10/2023

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