Healthcare Provider Details

I. General information

NPI: 1053957431
Provider Name (Legal Business Name): ENCORE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12454 WINDERMERE OAKS CT
BATON ROUGE LA
70810-0910
US

IV. Provider business mailing address

12454 WINDERMERE OAKS CT
BATON ROUGE LA
70810-0910
US

V. Phone/Fax

Practice location:
  • Phone: 225-413-8057
  • Fax: 225-924-8085
Mailing address:
  • Phone: 225-413-8057
  • Fax: 225-924-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARK W GALLEGOS
Title or Position: OWNER
Credential:
Phone: 225-413-8057