Provider Demographics
NPI:1285311704
Name:QUALITY MED TRANSPORT LLC
Entity type:Organization
Organization Name:QUALITY MED TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBALUKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-587-5763
Mailing Address - Street 1:5501 JACKSBORO HWY STE 606
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114-1662
Mailing Address - Country:US
Mailing Address - Phone:214-587-5763
Mailing Address - Fax:817-420-6444
Practice Address - Street 1:5501 JACKSBORO HWY STE 606
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76114-1662
Practice Address - Country:US
Practice Address - Phone:214-587-5763
Practice Address - Fax:817-420-6444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)