Healthcare Provider Details

I. General information

NPI: 1508544768
Provider Name (Legal Business Name): UNITED CARE TRANSPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 JESSE JAMES CT
BOONVILLE MO
65233-2874
US

IV. Provider business mailing address

1728 JESSE JAMES CT
BOONVILLE MO
65233-2874
US

V. Phone/Fax

Practice location:
  • Phone: 816-416-6142
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name: JORDAN MERTGEN
Title or Position: CEO
Credential:
Phone: 816-416-6142