=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528873833
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHYNE & WELLS TRANSPORTATION SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2025
-----------------------------------------------------
Last Update Date | 02/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10000 KEDGWICK CT
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71118-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-870-8375
-----------------------------------------------------
Fax | 832-835-2102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10000 KEDGWICK CT
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71118-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-870-8375
-----------------------------------------------------
Fax | 832-835-2102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO OWNER
-----------------------------------------------------
Name | DR. LATRISALA BANKSTON
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 832-571-1935
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------