MEDICARE: SUPERTRANSPORT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1205635075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERTRANSPORT LLC

Provider Business Mailing Address
First Line	:	303 LINCOLN RD
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71203-4247
Country	:	US
Telephone Number	:	318-557-0125
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 LINCOLN RD
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71203-4247
Country	:	US
Telephone Number	:	318-557-0125
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	HAROON ROY
Credential	:	OWNER
Telephone Number	:	318-557-0125

Provider Enumeration Date	:	03/12/2025
Last Update Date	:	03/12/2025

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