Provider Demographics
NPI:1396871356
Name:MORGANTOWN TRANSPORTATION CENTER
Entity type:Organization
Organization Name:MORGANTOWN TRANSPORTATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-548-2201
Mailing Address - Street 1:400 REDLAND CT
Mailing Address - Street 2:SUITE 114
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3270
Mailing Address - Country:US
Mailing Address - Phone:443-548-2200
Mailing Address - Fax:443-548-2260
Practice Address - Street 1:342 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-9407
Practice Address - Country:US
Practice Address - Phone:270-662-0045
Practice Address - Fax:270-662-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY56020738Medicaid
KY56020720Medicaid
KY56023229Medicaid