MEDICARE: KCC TRANSPORT

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	:	1730736455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KCC TRANSPORT

Provider Business Mailing Address
First Line	:	540 MEADOWSHIRE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-4414
Country	:	US
Telephone Number	:	214-985-4294
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 MEADOWSHIRE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75232-4414
Country	:	US
Telephone Number	:	214-985-4294
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. EDWIN PETERS
Credential	:
Telephone Number	:	214-985-4294

Provider Enumeration Date	:	08/19/2019
Last Update Date	:	08/19/2019

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Directions to “KCC TRANSPORT ” Practice Location

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