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General NPI Number Information
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NPI Number | 1649947508
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Entity Type | Organization
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Legal Business Name | 17:7 INFINITY LLC
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 2800 YOUREE DR STE 473
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City | SHREVEPORT
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State | LA
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Zip | 71104-3666
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Country | US
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Telephone | 318-401-4058
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19245
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City | SHREVEPORT
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State | LA
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Zip | 71149-0245
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Country | US
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Telephone | 318-401-4058
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EBONY LUKINDA HULLABY
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Credential |
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Telephone | 318-401-4058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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