Healthcare Provider Details

I. General information

NPI: 1962668780
Provider Name (Legal Business Name): EAST BR MEDICAL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 N 16TH ST
BATON ROUGE LA
70802-3510
US

IV. Provider business mailing address

1755 N 16TH ST
BATON ROUGE LA
70802-3510
US

V. Phone/Fax

Practice location:
  • Phone: 225-978-2749
  • Fax:
Mailing address:
  • Phone: 225-978-2749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number003951623
License Number StateLA

VIII. Authorized Official

Name: MS. MISHELL RICHARDSON
Title or Position: MEDICALTRANSPORTATION
Credential:
Phone: 225-978-2749