Provider Demographics
NPI:1760585012
Name:K & L TRANSPORT
Entity Type:Organization
Organization Name:K & L TRANSPORT
Other - Org Name:K & L TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEITA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:POTEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-626-4749
Mailing Address - Street 1:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:JEWETT
Mailing Address - State:TX
Mailing Address - Zip Code:75846-0422
Mailing Address - Country:US
Mailing Address - Phone:903-626-4749
Mailing Address - Fax:
Practice Address - Street 1:419 LEATHERS LN
Practice Address - Street 2:
Practice Address - City:JEWETT
Practice Address - State:TX
Practice Address - Zip Code:75846
Practice Address - Country:US
Practice Address - Phone:903-626-4749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3001643416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000624901Medicaid
TX528229Medicare PIN