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General NPI Number Information
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NPI Number | 1760875959
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Entity Type | Organization
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Legal Business Name | POSITIVE CHANGE TRANSPORTATION, LLC
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Dates
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Enumeration Date | 03/11/2015
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 348 W 79TH ST
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City | SHREVEPORT
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State | LA
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Zip | 71106-4820
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Country | US
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Telephone | 318-688-8192
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Fax | 318-688-8193
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Provider Business Mailing Address
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Address Line | 6461 BUNCOMBE RD
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City | SHREVEPORT
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State | LA
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Zip | 71129-4305
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Country | US
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Telephone | 318-688-8192
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Fax | 318-688-8193
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARTY TYRONE JOHNSON SR.
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Credential |
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Telephone | 318-779-8527
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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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