Healthcare Provider Details

I. General information

NPI: 1417675422
Provider Name (Legal Business Name): LOCUST TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 UNIONVILLE INDIAN TRAIL RD W
INDIAN TRAIL NC
28079-6757
US

IV. Provider business mailing address

2308 UNIONVILLE INDIAN TRAIL RD W
INDIAN TRAIL NC
28079-6757
US

V. Phone/Fax

Practice location:
  • Phone: 704-267-0367
  • Fax:
Mailing address:
  • Phone: 704-267-0367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: KATINA LIVINGSTON
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 704-267-0367