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General NPI Number Information
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NPI Number | 1467083931
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Entity Type | Organization
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Legal Business Name | WILSON TRANSPORTATION
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Dates
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Enumeration Date | 02/03/2020
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 100 DIPLOMAT WAY
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City | THIBODAUX
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State | LA
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Zip | 70301-4314
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Country | US
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Telephone | 985-316-6483
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Fax |
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Provider Business Mailing Address
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Address Line | 100 DIPLOMAT WAY
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City | THIBODAUX
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State | LA
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Zip | 70301-4314
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Country | US
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Telephone | 985-316-6483
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEROME WILSON
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Credential |
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Telephone | 985-316-6483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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