Provider Demographics
NPI:1760710933
Name:KINGDOM TRANSPORTATION, INC.
Entity Type:Organization
Organization Name:KINGDOM TRANSPORTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-231-0707
Mailing Address - Street 1:4701 NEW BERN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1547
Mailing Address - Country:US
Mailing Address - Phone:919-231-0707
Mailing Address - Fax:919-231-0709
Practice Address - Street 1:4701 NEW BERN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1547
Practice Address - Country:US
Practice Address - Phone:919-231-0707
Practice Address - Fax:919-231-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCYZN7122343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)