Provider Demographics
NPI:1881117257
Name:KINGSLEY MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:KINGSLEY MEDICAL TRANSPORTATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBRAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-599-6573
Mailing Address - Street 1:7123 RUNNYMEDE TRL
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7486
Mailing Address - Country:US
Mailing Address - Phone:703-599-6573
Mailing Address - Fax:540-388-2665
Practice Address - Street 1:7123 RUNNYMEDE TRL
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7486
Practice Address - Country:US
Practice Address - Phone:703-599-6573
Practice Address - Fax:540-388-2665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)