MEDICARE: BIG O' BET RIDES

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	:	1396470159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIG O' BET RIDES

Provider Business Mailing Address
First Line	:	11843 BRICKSOME AVE STE C
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-5310
Country	:	US
Telephone Number	:	318-359-2320
Fax Number	:	225-382-0023

Provider Business Practice Location Address
First Line	:	11843 BRICKSOME AVE STE C
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-5310
Country	:	US
Telephone Number	:	318-359-2320
Fax Number	:	225-382-0023

Authorized Official
Title or Position	:	MANAGER
Name	:	GABRIELLE SMITH
Credential	:
Telephone Number	:	318-359-2320

Provider Enumeration Date	:	07/17/2022
Last Update Date	:	07/17/2022

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