Provider Demographics
NPI:1457995003
Name:KINGSWAY MEDICAL TRANSPORT LLC
Entity type:Organization
Organization Name:KINGSWAY MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-763-9983
Mailing Address - Street 1:9970 E PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-8910
Mailing Address - Country:US
Mailing Address - Phone:937-763-9983
Mailing Address - Fax:614-890-7374
Practice Address - Street 1:938 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-7656
Practice Address - Country:US
Practice Address - Phone:937-402-4070
Practice Address - Fax:614-890-7374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport