Provider Demographics
NPI:1861554016
Name:BJK, LLC
Entity type:Organization
Organization Name:BJK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:KUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:918-488-6150
Mailing Address - Street 1:8222 E 103RD ST STE 132
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7027
Mailing Address - Country:US
Mailing Address - Phone:918-369-4848
Mailing Address - Fax:918-369-4849
Practice Address - Street 1:5521 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6008
Practice Address - Country:US
Practice Address - Phone:918-622-7272
Practice Address - Fax:918-622-7276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK74332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5593090001Medicare ID - Type Unspecified