MEDICARE: MRS. ANGELA POKE HAMILTON

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	:	1669769626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA POKE HAMILTON

Provider Business Mailing Address
First Line	:	3793 HENDERSON LOOP
Second Line	:
City	:	SONDHEIMER
State	:	LA
Zip	:	71276-5308
Country	:	US
Telephone Number	:	318-341-6669
Fax Number	:

Provider Business Practice Location Address
First Line	:	3793 HENDERSON LOOP
Second Line	:
City	:	SONDHEIMER
State	:	LA
Zip	:	71276-5308
Country	:	US
Telephone Number	:	318-267-2267
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	07/18/2022

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