Healthcare Provider Details

I. General information

NPI: 1588163703
Provider Name (Legal Business Name): FAMILY FAITH MEDICAL TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 MESQUITE DR
GALLUP NM
87301-5741
US

IV. Provider business mailing address

1710 MESQUITE DR
GALLUP NM
87301-5741
US

V. Phone/Fax

Practice location:
  • Phone: 505-879-6971
  • Fax: 505-488-2495
Mailing address:
  • Phone: 505-879-6971
  • Fax: 505-488-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateAR

VIII. Authorized Official

Name: LAKERRA L KEE
Title or Position: OWNER/CEO
Credential:
Phone: 505-879-6971