Healthcare Provider Details

I. General information

NPI: 1891394979
Provider Name (Legal Business Name): M.D.O. TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 RUE ST LOUIS LOOP
COVINGTON LA
70435-2004
US

IV. Provider business mailing address

2207 RUE ST LOUIS LOOP
COVINGTON LA
70435-2004
US

V. Phone/Fax

Practice location:
  • Phone: 504-516-9285
  • Fax:
Mailing address:
  • Phone: 504-516-9285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. DEMETRA HENDERSON
Title or Position: CEO
Credential:
Phone: 504-516-9285