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General NPI Number Information
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NPI Number | 1669156865
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Entity Type | Organization
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Legal Business Name | KG INDUSTRIES
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Dates
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Enumeration Date | 06/09/2023
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 10509 TURNING LEAF LN
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City | SPOTSYLVANIA
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State | VA
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Zip | 22551-8909
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Country | US
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Telephone | 540-735-4535
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Fax |
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Provider Business Mailing Address
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Address Line | 10509 TURNING LEAF LN
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City | SPOTSYLVANIA
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State | VA
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Zip | 22551-8909
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Country | US
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Telephone | 540-735-4535
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DARIN M UPDYKE
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Credential | PHYSICIAN ASSISTANT
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Telephone | 540-735-4535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 342000000X
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Taxonomy Name | Transportation Network Company
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License Number |
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License Number State |
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