Healthcare Provider Details

I. General information

NPI: 1124415997
Provider Name (Legal Business Name): KSL TRANSPORTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15276 481ST AVE
MILBANK SD
57252-6009
US

IV. Provider business mailing address

15276 481ST AVE
MILBANK SD
57252-6009
US

V. Phone/Fax

Practice location:
  • Phone: 605-884-7191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: KYLE SCHWEER
Title or Position: PRESIDENT
Credential:
Phone: 605-237-2679