Provider Demographics
NPI:1437598661
Name:K-TOWN RIDERS
Entity Type:Organization
Organization Name:K-TOWN RIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEELIN
Authorized Official - Middle Name:JAFARI
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-208-2249
Mailing Address - Street 1:4415 WHITTLE SPRINGS RD
Mailing Address - Street 2:APT 30
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-1544
Mailing Address - Country:US
Mailing Address - Phone:865-208-2249
Mailing Address - Fax:877-703-3065
Practice Address - Street 1:4415 WHITTLE SPRINGS RD
Practice Address - Street 2:APT 30
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1544
Practice Address - Country:US
Practice Address - Phone:865-208-2249
Practice Address - Fax:877-703-3065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGMedicaid