Provider Demographics
NPI:1336889088
Name:KC CHAUFFEUR LLC
Entity Type:Organization
Organization Name:KC CHAUFFEUR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:MECHELLE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-977-5341
Mailing Address - Street 1:804 BROADWAY BLVD UNIT 103
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-1679
Mailing Address - Country:US
Mailing Address - Phone:816-977-5341
Mailing Address - Fax:
Practice Address - Street 1:2505 E 39TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-2440
Practice Address - Country:US
Practice Address - Phone:816-588-9474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)