Provider Demographics
NPI:1790341345
Name:MK&S TRANSPORTATION LLC
Entity Type:Organization
Organization Name:MK&S TRANSPORTATION LLC
Other - Org Name:MK&S TRANSPORTATION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-609-5208
Mailing Address - Street 1:1504 MACALPIN CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-7840
Mailing Address - Country:US
Mailing Address - Phone:757-609-5208
Mailing Address - Fax:
Practice Address - Street 1:1504 MACALPIN CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-7840
Practice Address - Country:US
Practice Address - Phone:757-609-5208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-18
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT62658219OtherDMV