=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336509678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TWIN CITY RELIABLE TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2016
-----------------------------------------------------
Last Update Date | 02/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2107 HONOR ST STE A
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71201-3649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-699-3888
-----------------------------------------------------
Fax | 318-340-0515
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2107 HONOR ST STE A
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71201-3649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-699-3888
-----------------------------------------------------
Fax | 318-340-0515
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. LARRY SPENCER BURRELL SR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 318-512-5808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | NE0011312
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------