MEDICARE: KMH TRANSPORTION SERVICE

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	:	1730759820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KMH TRANSPORTION SERVICE

Provider Business Mailing Address
First Line	:	2332 WESTPORT DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-1243
Country	:	US
Telephone Number	:	937-607-2277
Fax Number	:

Provider Business Practice Location Address
First Line	:	2332 WESTPORT DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-1243
Country	:	US
Telephone Number	:	937-607-2277
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELLEY HAIRSTON
Credential	:
Telephone Number	:	937-607-2277

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	06/30/2021

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Directions to “KMH TRANSPORTION SERVICE ” Practice Location

Language	Start Address	Practice Location

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