Healthcare Provider Details

I. General information

NPI: 1093547010
Provider Name (Legal Business Name): KHOGALI TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 AVON RD
UPPER DARBY PA
19082-3903
US

IV. Provider business mailing address

209 AVON RD
UPPER DARBY PA
19082-3903
US

V. Phone/Fax

Practice location:
  • Phone: 445-448-5020
  • Fax:
Mailing address:
  • Phone: 445-448-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: AHMED KHOGALI
Title or Position: OWNER
Credential:
Phone: 445-448-5020