MEDICARE: MR. GARY WAYNE SEETS

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	:	1740492776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY WAYNE SEETS

Provider Business Mailing Address
First Line	:	8825 W SAINT HELENS DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-5349
Country	:	US
Telephone Number	:	318-775-0575
Fax Number	:	318-775-0576

Provider Business Practice Location Address
First Line	:	8825 W SAINT HELENS DR
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71108-5349
Country	:	US
Telephone Number	:	318-775-0575
Fax Number	:	318-775-0576

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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