Healthcare Provider Details

I. General information

NPI: 1396871356
Provider Name (Legal Business Name): MORGANTOWN TRANSPORTATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 S MAIN ST
MORGANTOWN KY
42261-9407
US

IV. Provider business mailing address

400 REDLAND CT SUITE 114
OWINGS MILLS MD
21117-3270
US

V. Phone/Fax

Practice location:
  • Phone: 270-662-0045
  • Fax: 270-662-0053
Mailing address:
  • Phone: 443-548-2200
  • Fax: 443-548-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KRIS W. BALDOCK
Title or Position: CHAIRMAN, CEO, PRESIDENT
Credential:
Phone: 443-548-2201