Provider Demographics
NPI:1700233616
Name:KHOLBAS INC, DBA SORIBA.ORG TRANSPORTATION
Entity Type:Organization
Organization Name:KHOLBAS INC, DBA SORIBA.ORG TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IBRAHIMA
Authorized Official - Middle Name:SORIBA
Authorized Official - Last Name:BANGOURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-293-2275
Mailing Address - Street 1:PO BOX 2172
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110-2172
Mailing Address - Country:US
Mailing Address - Phone:800-201-9181
Mailing Address - Fax:
Practice Address - Street 1:125 S 600 E APT 3
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1939
Practice Address - Country:US
Practice Address - Phone:800-201-9181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTLIC2015-00931343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)