Basic Information
| Provider Information | |||||||||
| NPI: | 1194278317 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KINGDOM MEDICAL TRANSPORTATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16510 BOBSTER CT | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221916316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035976529 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16510 BOBSTER CT | ||||||||
| Address2: | |||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221916316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035976529 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2016 | ||||||||
| LastUpdateDate: | 07/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | FYNN | ||||||||
| AuthorizedOfficialFirstName: | ABENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7035976529 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 343900000X | Y | Transportation Services | Non-emergency Medical Transport (VAN) |
No ID Information.