Provider Demographics
NPI:1205660941
Name:KING TUT LOGISTICS
Entity type:Organization
Organization Name:KING TUT LOGISTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DRIVER
Authorized Official - Prefix:
Authorized Official - First Name:MOSTAFA
Authorized Official - Middle Name:IBRAHIM
Authorized Official - Last Name:HASSANEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-832-0366
Mailing Address - Street 1:215 GRACYN OLIVIA DR APT 406
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-6537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 GRACYN OLIVIA DR APT 406
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-6537
Practice Address - Country:US
Practice Address - Phone:817-832-0366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)