MEDICARE: KLW TRANSPORTATION L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1275319113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KLW TRANSPORTATION L.L.C.

Provider Business Mailing Address
First Line	:	1416 1/2 N POPLAR ST
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-4237
Country	:	US
Telephone Number	:	501-681-7167
Fax Number	:

Provider Business Practice Location Address
First Line	:	1416 1/2 N POPLAR ST
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-4237
Country	:	US
Telephone Number	:	501-681-7167
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KERRY L WOOLFOLK
Credential	:
Telephone Number	:	501-681-7167

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	09/06/2023

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