Healthcare Provider Details

I. General information

NPI: 1184481426
Provider Name (Legal Business Name): NORTH LOUISIANA MEDICAL TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 DESIARD PLAZA DR
MONROE LA
71203-4922
US

IV. Provider business mailing address

350 DESIARD PLAZA DR
MONROE LA
71203-4922
US

V. Phone/Fax

Practice location:
  • Phone: 318-379-4244
  • Fax:
Mailing address:
  • Phone: 318-379-4244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: CALISHA FORTNER
Title or Position: PRINCIPLE
Credential:
Phone: 318-379-4244