MEDICARE: MOVEABLE TRANSPORTATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1093316523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOVEABLE TRANSPORTATION

Provider Business Mailing Address
First Line	:	1020 RIDGEWOOD DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3434
Country	:	US
Telephone Number	:	318-207-0546
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 RIDGEWOOD DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118-3434
Country	:	US
Telephone Number	:	318-207-0546
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GERMAINE DESHUNE GAY
Credential	:
Telephone Number	:	318-207-0546

Provider Enumeration Date	:	11/02/2020
Last Update Date	:	11/02/2020

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Directions to “MOVEABLE TRANSPORTATION ” Practice Location

Language	Start Address	Practice Location

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