Provider Demographics
NPI:1063193118
Name:UGBAJAH, PRINCEWILL
Entity type:Individual
Prefix:MR
First Name:PRINCEWILL
Middle Name:
Last Name:UGBAJAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 SW MISSION RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3524
Mailing Address - Country:US
Mailing Address - Phone:816-679-9345
Mailing Address - Fax:
Practice Address - Street 1:1436 SW MISSION RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-3524
Practice Address - Country:US
Practice Address - Phone:816-679-9345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO343900000X, 342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)