Provider Demographics
NPI:1528697406
Name:BROWN, KENNETH ELWOOD JR
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:ELWOOD
Last Name:BROWN
Suffix:JR
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 1:2056 INTEGRITY DR S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2728
Mailing Address - Country:US
Mailing Address - Phone:614-648-5111
Mailing Address - Fax:
Practice Address - Street 1:2056 INTEGRITY DR S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2728
Practice Address - Country:US
Practice Address - Phone:614-648-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH25-361-5343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)