MEDICARE: SECURE PATIENT DELIVERY OF MONROE, LLC

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	343800000X	Secured Medical Transport (VAN)
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1750047858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECURE PATIENT DELIVERY OF MONROE, LLC

Provider Business Mailing Address
First Line	:	4650 W ESPLANADE AVE STE 200
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70006-2765
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 CENTURY VILLAGE BLVD STE 200
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71203-2008
Country	:	US
Telephone Number	:	337-443-4830
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROTEM M DAHAN
Credential	:
Telephone Number	:	504-258-2335

Provider Enumeration Date	:	11/12/2021
Last Update Date	:	11/12/2021

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