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General NPI Number Information
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NPI Number | 1962668780
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Entity Type | Organization
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Legal Business Name | EASTB.R.MEDICALTRANSPORTATION
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 1755NORTH16ST.
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City | BATONROUGE
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State | LA
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Zip | 70802
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Country | US
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Telephone | 225-978-2749
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Fax |
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Provider Business Mailing Address
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Address Line | 1755NORTH 16THST.
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City | BATONROUGE
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State | LA
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Zip | 70802
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Country | US
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Telephone | 225-978-2749
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Fax |
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Authorized Official
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Title or Position | MEDICALTRANSPORTATIPN
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Name | MS. MISHELL RICHARDSON
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Credential |
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Telephone | 225-978-2749
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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 | 003951623
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License Number State | LA
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