Healthcare Provider Details

I. General information

NPI: 1700614955
Provider Name (Legal Business Name): KOJMAR TRANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17611 114TH ST E
BONNEY LAKE WA
98391-8196
US

IV. Provider business mailing address

17611 114TH ST E
BONNEY LAKE WA
98391-8196
US

V. Phone/Fax

Practice location:
  • Phone: 630-915-5938
  • Fax:
Mailing address:
  • Phone: 630-915-5938
  • 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 Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MARIAN E ERZUAH
Title or Position: PRESIDENT
Credential:
Phone: 630-915-5938