Provider Demographics
NPI:1376901967
Name:KINGDOM TRANSPORT LLC
Entity Type:Organization
Organization Name:KINGDOM TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-713-6295
Mailing Address - Street 1:12230 FOREST HILL BLVD
Mailing Address - Street 2:110 KK
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-5700
Mailing Address - Country:US
Mailing Address - Phone:561-651-9618
Mailing Address - Fax:561-651-9618
Practice Address - Street 1:12230 FOREST HILL BLVD
Practice Address - Street 2:110 KK
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5700
Practice Address - Country:US
Practice Address - Phone:561-651-9618
Practice Address - Fax:561-651-9618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)