Provider Demographics
NPI:1518470608
Name:WELLNESS MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:WELLNESS MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KANGOGO
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:913-270-4210
Mailing Address - Street 1:10419 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-1529
Mailing Address - Country:US
Mailing Address - Phone:913-270-4210
Mailing Address - Fax:
Practice Address - Street 1:10419 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-1529
Practice Address - Country:US
Practice Address - Phone:913-270-4210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001531713343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)