Healthcare Provider Details

I. General information

NPI: 1134845431
Provider Name (Legal Business Name): UDO TRANSPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 NAPERVILLE DR
CARY NC
27519-8393
US

IV. Provider business mailing address

964 HIGH HOUSE RD # 3115
CARY NC
27513-3574
US

V. Phone/Fax

Practice location:
  • Phone: 919-766-8394
  • 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 State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: FAITH NKWONTA
Title or Position: OWNER
Credential: RN
Phone: 919-766-8394