MEDICARE: CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF KY INC

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	3416A0800X	Air Ambulance	1611	KY

General Provider Information

NPI Number	:	1598935017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CJ CRITICAL CARE TRANSPORTATION SYSTEMS OF KY INC

Provider Business Mailing Address
First Line	:	621 CARNEGIE DR
Second Line	:	205
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3536
Country	:	US
Telephone Number	:	800-499-9495
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 ISLAND CREEK RD
Second Line	:
City	:	PIKEVILLE
State	:	KY
Zip	:	41501-9341
Country	:	US
Telephone Number	:	606-437-6620
Fax Number	:

Authorized Official
Title or Position	:	NATIONAL DIRECTOR
Name	:	MARK KEENE
Credential	:
Telephone Number	:	909-915-2303

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	02/12/2009

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