Provider Demographics
NPI:1376015792
Name:KENNTONI MEDICAL CORP
Entity Type:Organization
Organization Name:KENNTONI MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:N
Authorized Official - Last Name:AGBODIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-405-8863
Mailing Address - Street 1:3 WASHAKIE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02911-3532
Mailing Address - Country:US
Mailing Address - Phone:401-405-8863
Mailing Address - Fax:401-270-6433
Practice Address - Street 1:3 WASHAKIE AVE FL 2
Practice Address - Street 2:
Practice Address - City:N PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-3532
Practice Address - Country:US
Practice Address - Phone:401-405-8863
Practice Address - Fax:401-270-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-24
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)