Healthcare Provider Details

I. General information

NPI: 1003653338
Provider Name (Legal Business Name): LTK RELIABLE TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 ELMDALE DR
SAINT LOUIS MO
63135-3006
US

IV. Provider business mailing address

293 ELMDALE DR
SAINT LOUIS MO
63135-3006
US

V. Phone/Fax

Practice location:
  • Phone: 314-898-5745
  • Fax:
Mailing address:
  • Phone: 314-898-5745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY BROWN
Title or Position: OWNER
Credential:
Phone: 314-898-5745