Healthcare Provider Details

I. General information

NPI: 1720806458
Provider Name (Legal Business Name): NORTHEAST WELLNESS MEDICAL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 KIROLI RD APT 4
WEST MONROE LA
71291-7096
US

IV. Provider business mailing address

1700 POWELL ST
MONROE LA
71203-5752
US

V. Phone/Fax

Practice location:
  • Phone: 318-396-8500
  • Fax:
Mailing address:
  • Phone: 318-396-8500
  • 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: AERIANA MON'EY SMITH
Title or Position: OWNER
Credential:
Phone: 318-369-8500