Healthcare Provider Details

I. General information

NPI: 1790491090
Provider Name (Legal Business Name): M AND K SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4067 WOODSLY DR
BATAVIA OH
45103-7551
US

IV. Provider business mailing address

4067 WOODSLY DR
BATAVIA OH
45103-7551
US

V. Phone/Fax

Practice location:
  • Phone: 513-535-6451
  • Fax: 833-743-5214
Mailing address:
  • Phone: 513-535-6451
  • Fax: 833-743-5214

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: JILL M LATHAM
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 937-309-3017