Healthcare Provider Details

I. General information

NPI: 1326839960
Provider Name (Legal Business Name): GULF MARINE TRANSPORTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7142 EDGEWATER DR
MANDEVILLE LA
70471-7432
US

IV. Provider business mailing address

7142 EDGEWATER DR
MANDEVILLE LA
70471-7432
US

V. Phone/Fax

Practice location:
  • Phone: 361-446-2523
  • Fax:
Mailing address:
  • Phone: 361-446-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOHN B. HARVEY
Title or Position: MEMBER
Credential:
Phone: 361-446-2523