Provider Demographics
NPI:1508612326
Name:KTK TRANSPORT LLC
Entity Type:Organization
Organization Name:KTK TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIDUS
Authorized Official - Middle Name:T
Authorized Official - Last Name:KIDANKAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-459-6629
Mailing Address - Street 1:5616 BELLISSIMA WAY
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2667
Mailing Address - Country:US
Mailing Address - Phone:703-459-6629
Mailing Address - Fax:
Practice Address - Street 1:5616 BELLISSIMA WAY
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2667
Practice Address - Country:US
Practice Address - Phone:703-459-6629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)