Provider Demographics
NPI:1669705463
Name:KT EXPRESS
Entity type:Organization
Organization Name:KT EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KING
Authorized Official - Middle Name:
Authorized Official - Last Name:UYERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-707-7385
Mailing Address - Street 1:6509 E OSBORN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6047
Mailing Address - Country:US
Mailing Address - Phone:480-707-7385
Mailing Address - Fax:480-323-2086
Practice Address - Street 1:6509 E OSBORN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6047
Practice Address - Country:US
Practice Address - Phone:480-707-7385
Practice Address - Fax:480-323-2086
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROYAL STYLE TRANS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31905343900000X, 344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ441704Medicaid