Provider Demographics
NPI:1720391949
Name:KING MEDICAL TRANSPORT, INC.
Entity Type:Organization
Organization Name:KING MEDICAL TRANSPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNNIE
Authorized Official - Middle Name:PARKS
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-528-3762
Mailing Address - Street 1:104 TIMBER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-9607
Mailing Address - Country:US
Mailing Address - Phone:336-528-3762
Mailing Address - Fax:
Practice Address - Street 1:104 TIMBER CREEK CT
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-9607
Practice Address - Country:US
Practice Address - Phone:336-528-3762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)