Healthcare Provider Details

I. General information

NPI: 1376113167
Provider Name (Legal Business Name): KIM,S TRANSPORT AND DELIVERY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SEWANEE DR
JACKSON MS
39209-3928
US

IV. Provider business mailing address

125 SEWANEE DR
JACKSON MS
39209-3928
US

V. Phone/Fax

Practice location:
  • Phone: 601-454-8269
  • Fax:
Mailing address:
  • Phone: 601-454-8269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY DENISE SMITH
Title or Position: OWNER
Credential:
Phone: 601-454-8269