MEDICARE: KINGDOM TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1649813494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGDOM TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	1401 E 153RD ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-2832
Country	:	US
Telephone Number	:	913-548-2798
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 E 153RD ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-2832
Country	:	US
Telephone Number	:	913-548-2798
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PENINAH MWACHIA
Credential	:
Telephone Number	:	913-548-2798

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	10/24/2019

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Directions to “KINGDOM TRANSPORTATION LLC ” Practice Location

Language	Start Address	Practice Location

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