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General NPI Number Information
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NPI Number | 1194140103
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Entity Type | Organization
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Legal Business Name | KACZOR ENTERPRISES INC
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Dates
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Enumeration Date | 02/27/2014
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 55 DELLMONTE RD
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City | DOUGLAS
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State | GA
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Zip | 31535-6135
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Country | US
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Telephone | 912-592-3643
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Fax | 912-393-1011
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Provider Business Mailing Address
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Address Line | 2236 MCKINNON RD
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City | DOUGLAS
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State | GA
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Zip | 31535-3102
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Country | US
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Telephone | 912-592-3643
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Fax | 912-393-1011
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Authorized Official
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Title or Position | CEO
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Name | JOHN R KEANON
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Credential |
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Telephone | 912-592-3643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 034-02
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License Number State | GA
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