Provider Demographics
NPI:1285777821
Name:K.R.J. TRANSIT, INCORPARTED
Entity type:Organization
Organization Name:K.R.J. TRANSIT, INCORPARTED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUDDLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-289-2526
Mailing Address - Street 1:813 APACHE AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047
Mailing Address - Country:US
Mailing Address - Phone:928-289-2526
Mailing Address - Fax:928-289-2527
Practice Address - Street 1:813 N APACHE AVE
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047-3818
Practice Address - Country:US
Practice Address - Phone:928-289-2526
Practice Address - Fax:928-289-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ143543Medicaid