Basic Information
| Provider Information | |||||||||
| NPI: | 1396871356 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MORGANTOWN TRANSPORTATION CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 REDLAND CT | ||||||||
| Address2: | SUITE 114 | ||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211173270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4435482200 | ||||||||
| FaxNumber: | 4435482260 | ||||||||
| Practice Location | |||||||||
| Address1: | 342 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422619407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706620045 | ||||||||
| FaxNumber: | 2706620053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BALDOCK | ||||||||
| AuthorizedOfficialFirstName: | KRIS | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHAIRMAN, CEO, PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4435482201 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 347E00000X | Y | Transportation Services | Transportation Broker |
ID Information
| ID | Type | State | Issuer | Description | 56020738 | 05 | KY | MEDICAID | 56020720 | 05 | KY | MEDICAID | 56023229 | 05 | KY | MEDICAID |