=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174974539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K&L MEDICAL TRANSPORTATION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2016
-----------------------------------------------------
Last Update Date | 06/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3629 SUNSET LN
-----------------------------------------------------
City | WILLIAMSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14589-9223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-301-3827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 411
-----------------------------------------------------
City | WILLIAMSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14589-0411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-589-2234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MRS. LATASHA J FELTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-589-2234
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------