MEDICARE: ALPHA & OMEGA TRANSPORTATION

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)		LA

General Provider Information

NPI Number	:	1215469168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA & OMEGA TRANSPORTATION

Provider Business Mailing Address
First Line	:	12011 BRICKSON AVE.
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2339
Country	:	US
Telephone Number	:	337-515-1491
Fax Number	:

Provider Business Practice Location Address
First Line	:	12011 BRICKSOME AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2339
Country	:	US
Telephone Number	:	337-515-1491
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SHADY PATTON III
Credential	:
Telephone Number	:	337-515-1491

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	03/30/2017

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Directions to “ALPHA & OMEGA TRANSPORTATION ” Practice Location

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