Provider Demographics
NPI:1932876752
Name:KMK NATIONWIDE TRANSPORT LLC
Entity Type:Organization
Organization Name:KMK NATIONWIDE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KAISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-425-9490
Mailing Address - Street 1:1315 WOODGROVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-1595
Mailing Address - Country:US
Mailing Address - Phone:314-425-9490
Mailing Address - Fax:
Practice Address - Street 1:1315 WOODGROVE PARK DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-1595
Practice Address - Country:US
Practice Address - Phone:314-425-9490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)