Healthcare Provider Details

I. General information

NPI: 1891277851
Provider Name (Legal Business Name): GEVITYLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 HOUMA BLVD
METAIRIE LA
70001-1382
US

IV. Provider business mailing address

7001 BUNDY RD APT R10
NEW ORLEANS LA
70127-2173
US

V. Phone/Fax

Practice location:
  • Phone: 504-261-2811
  • Fax:
Mailing address:
  • Phone: 504-261-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. KEYOTA ANDREA RUSSELL
Title or Position: OWNER/ PROVIDER
Credential: GEVITY
Phone: 504-261-2811