MEDICARE: MJKNIGHT ENTERPRISE 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	343900000X	Non-emergency Medical Transport (VAN)	04986016	IL

General Provider Information

NPI Number	:	1710381827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MJKNIGHT ENTERPRISE LLC

Provider Business Mailing Address
First Line	:	5411 S HOYNE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-5548
Country	:	US
Telephone Number	:	773-750-0832
Fax Number	:	773-897-5827

Provider Business Practice Location Address
First Line	:	5411 S HOYNE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-5548
Country	:	US
Telephone Number	:	773-750-0832
Fax Number	:	773-897-5827

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. MONIQUE JONNEL MCKNIGHT
Credential	:
Telephone Number	:	773-750-0832

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	02/05/2015

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