Healthcare Provider Details

I. General information

NPI: 1316688831
Provider Name (Legal Business Name): KOUFFA TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 W MAIN ST APT 101
SUN PRAIRIE WI
53590-4616
US

IV. Provider business mailing address

3211 W MAIN ST APT 1013211W
SUN PRAIRIE WI
53590-4616
US

V. Phone/Fax

Practice location:
  • Phone: 646-267-9233
  • Fax:
Mailing address:
  • Phone: 646-267-9233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: AMADOU BARRY
Title or Position: MANAGER
Credential:
Phone: 646-267-9233