=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760197578
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KOOL DRIVE ENTERPRISE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2023
-----------------------------------------------------
Last Update Date | 01/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 WESTWOOD LAKE CT
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-2993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-381-4994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1919 WESTWOOD LAKE CT
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-2993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-381-4994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RHONDA N DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 346-381-4994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------