Provider Demographics
NPI:1689109357
Name:SECURE MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:SECURE MEDICAL TRANSPORTATION
Other - Org Name:KENNETH LEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-981-2257
Mailing Address - Street 1:3285 HIGHWAY 1045
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-7239
Mailing Address - Country:US
Mailing Address - Phone:985-981-2257
Mailing Address - Fax:
Practice Address - Street 1:3285 HIGHWAY 1045
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-7239
Practice Address - Country:US
Practice Address - Phone:985-981-2257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SECURE MEDICAL TRANSPORTATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA937609343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)