Provider Demographics
NPI:1508673948
Name:K&K MEDICAL TRANSPORTATION
Entity type:Organization
Organization Name:K&K MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-951-8684
Mailing Address - Street 1:PO BOX 14063
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411-4063
Mailing Address - Country:US
Mailing Address - Phone:219-951-8684
Mailing Address - Fax:
Practice Address - Street 1:3953 ADAMS ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46408-2714
Practice Address - Country:US
Practice Address - Phone:219-951-8684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)