Provider Demographics
NPI:1891569422
Name:MCKNIGHT, ANTONIO W SR
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:W
Last Name:MCKNIGHT
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 STONE SHADOW DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-7165
Mailing Address - Country:US
Mailing Address - Phone:614-736-5080
Mailing Address - Fax:
Practice Address - Street 1:502 STONE SHADOW DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-7165
Practice Address - Country:US
Practice Address - Phone:614-736-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT692942343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)