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General NPI Number Information
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NPI Number | 1922894286
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Entity Type | Organization
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Legal Business Name | CANNON TRANSPORTATION SERVICES LLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 5612 W CANAL BLVD
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City | SHREVEPORT
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State | LA
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Zip | 71108-3602
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Country | US
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Telephone | 318-751-1232
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Fax |
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Provider Business Mailing Address
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Address Line | 512 FOX CV
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City | HAUGHTON
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State | LA
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Zip | 71037-9383
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Country | US
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Telephone | 318-751-1232
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | AMANDA CANNON
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Credential |
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Telephone | 318-751-1232
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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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