Provider Demographics
NPI:1275100323
Name:KOCH TRANSPORTATION SERVICES
Entity Type:Organization
Organization Name:KOCH TRANSPORTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TINYKO
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-887-8026
Mailing Address - Street 1:4046 WATER MILL DR STE 500
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7269
Mailing Address - Country:US
Mailing Address - Phone:678-887-8026
Mailing Address - Fax:
Practice Address - Street 1:4046 WATER MILL DR STE 500
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-7269
Practice Address - Country:US
Practice Address - Phone:678-887-8026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1417534066Medicaid