Provider Demographics
NPI:1134353535
Name:KVCAP TRANSPORTATION
Entity type:Organization
Organization Name:KVCAP TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRANSPORTATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-859-1564
Mailing Address - Street 1:97 WATER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6339
Mailing Address - Country:US
Mailing Address - Phone:207-859-1500
Mailing Address - Fax:207-872-6747
Practice Address - Street 1:97 WATER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6339
Practice Address - Country:US
Practice Address - Phone:207-859-1500
Practice Address - Fax:207-872-6747
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNEBEC VALLEY COMMUNITY ACTION PROGRAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103990300Medicaid