Provider Demographics
NPI:1245794908
Name:UNITED MEDICAL TRANSPORT OF KS, LLC
Entity Type:Organization
Organization Name:UNITED MEDICAL TRANSPORT OF KS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECOTR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JOURDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-622-6932
Mailing Address - Street 1:101 W 29TH ST STE G
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-2664
Mailing Address - Country:US
Mailing Address - Phone:417-622-6932
Mailing Address - Fax:
Practice Address - Street 1:101 W 29TH ST STE G #165
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-2664
Practice Address - Country:US
Practice Address - Phone:417-622-6932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201178350AOtherKMAP