Provider Demographics
NPI:1659128965
Name:KD TRIPLE M LOGISTIC
Entity type:Organization
Organization Name:KD TRIPLE M LOGISTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEYNIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-635-7843
Mailing Address - Street 1:18019 HERON FOREST LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2470
Mailing Address - Country:US
Mailing Address - Phone:281-790-2212
Mailing Address - Fax:
Practice Address - Street 1:18019 HERON FOREST LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2470
Practice Address - Country:US
Practice Address - Phone:281-790-2212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)