Healthcare Provider Details

I. General information

NPI: 1780305565
Provider Name (Legal Business Name): EXODUS MEDICAL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47378 ETHAN CT STE B
HAMMOND LA
70401-7218
US

IV. Provider business mailing address

47378 ETHAN CT STE B
HAMMOND LA
70401-7218
US

V. Phone/Fax

Practice location:
  • Phone: 985-981-8810
  • Fax:
Mailing address:
  • Phone: 985-551-1339
  • Fax: 985-387-8816

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: SORITA ELZEY
Title or Position: OWNER
Credential:
Phone: 985-981-4358