=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194328393
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REMARKABLE TRANSPORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2020
-----------------------------------------------------
Last Update Date | 11/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6205 HWY 5
-----------------------------------------------------
City | GLOSTER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-464-7116
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 91
-----------------------------------------------------
City | GLOSTER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71030-0091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-464-7116
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | KEYANDRA MICHELLE GRIFFIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 318-464-7116
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347E00000X
-----------------------------------------------------
Taxonomy Name | Transportation Broker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------