Provider Demographics
NPI:1740621986
Name:KAVKAZ TRANSPORTATION LLC
Entity type:Organization
Organization Name:KAVKAZ TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NODIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZAYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-629-0810
Mailing Address - Street 1:9316 EDDIE AND PARK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-2832
Mailing Address - Country:US
Mailing Address - Phone:314-629-0810
Mailing Address - Fax:
Practice Address - Street 1:9316 EDDIE AND PARK RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-2832
Practice Address - Country:US
Practice Address - Phone:314-629-0810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC1246482343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)