Provider Demographics
NPI:1174077879
Name:KORBANOT CORPORATION
Entity type:Organization
Organization Name:KORBANOT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LUMBUNGU WA RIKO
Authorized Official - Last Name:BUKASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-803-7272
Mailing Address - Street 1:207 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3855
Mailing Address - Country:US
Mailing Address - Phone:972-803-7272
Mailing Address - Fax:972-221-9305
Practice Address - Street 1:207 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3855
Practice Address - Country:US
Practice Address - Phone:972-803-7272
Practice Address - Fax:972-221-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
TX343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)