Healthcare Provider Details

I. General information

NPI: 1982167862
Provider Name (Legal Business Name): M&A MEDICAL TRANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3432 CHATEAU LN
LOUISVILLE KY
40219-2606
US

IV. Provider business mailing address

3432 CHATEAU LN
LOUISVILLE KY
40219-2606
US

V. Phone/Fax

Practice location:
  • Phone: 502-550-9444
  • Fax:
Mailing address:
  • Phone: 502-550-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. ABDELALI C GUENNOUNI
Title or Position: OWNER/OPERATOR
Credential:
Phone: 502-550-9444