Provider Demographics
NPI:1437964822
Name:KINCUSU MEDICAL TRANSPORT
Entity type:Organization
Organization Name:KINCUSU MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TOBECS
Authorized Official - Middle Name:
Authorized Official - Last Name:UGWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-422-9141
Mailing Address - Street 1:15190 PRESTONWOOD BLVD APT 116
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15190 PRESTONWOOD BLVD APT 116
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4732
Practice Address - Country:US
Practice Address - Phone:214-490-5359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-11
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)