Healthcare Provider Details

I. General information

NPI: 1063324697
Provider Name (Legal Business Name): MGT LOGISTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 SHAPLEY DR
SMYRNA DE
19977-6839
US

IV. Provider business mailing address

158 SHAPLEY DR
SMYRNA DE
19977-6839
US

V. Phone/Fax

Practice location:
  • Phone: 617-438-2382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JOHN NGUGI
Title or Position: OPERATIONS
Credential:
Phone: 617-438-2382