Provider Demographics
NPI:1285323584
Name:KERMIT LLC
Entity type:Organization
Organization Name:KERMIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:O
Authorized Official - Last Name:NASR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-401-8371
Mailing Address - Street 1:2148 W LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3506
Mailing Address - Country:US
Mailing Address - Phone:480-401-8371
Mailing Address - Fax:
Practice Address - Street 1:2148 W LAUREL LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-3506
Practice Address - Country:US
Practice Address - Phone:480-401-8371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)