Provider Demographics
NPI:1710473053
Name:KMT TRANSPORTATION
Entity Type:Organization
Organization Name:KMT TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:B
Authorized Official - Last Name:TIGOURTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-281-4496
Mailing Address - Street 1:7445 GITHENS AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-3161
Mailing Address - Country:US
Mailing Address - Phone:856-281-4496
Mailing Address - Fax:
Practice Address - Street 1:7445 GITHENS AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-3161
Practice Address - Country:US
Practice Address - Phone:856-281-4496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0442012343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0442012Medicaid