Provider Demographics
NPI:1639734189
Name:CAMELOT TRANSPORTATION INC
Entity Type:Organization
Organization Name:CAMELOT TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-293-0231
Mailing Address - Street 1:PO BOX 1808
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-1808
Mailing Address - Country:US
Mailing Address - Phone:308-455-1074
Mailing Address - Fax:
Practice Address - Street 1:1220 CENTRAL AVE STE 3
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-6811
Practice Address - Country:US
Practice Address - Phone:308-455-1074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026145600Medicaid