Provider Demographics
NPI:1114229663
Name:KOTA TRANSPORT SERVICE, LLC.
Entity Type:Organization
Organization Name:KOTA TRANSPORT SERVICE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MOSES
Authorized Official - Last Name:BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-883-1693
Mailing Address - Street 1:1125 S CAMBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27801-7444
Mailing Address - Country:US
Mailing Address - Phone:252-883-1693
Mailing Address - Fax:252-467-1079
Practice Address - Street 1:1125 S CAMBRIDGE CIR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-7444
Practice Address - Country:US
Practice Address - Phone:252-883-1693
Practice Address - Fax:252-467-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3393964343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)