MEDICARE: FOXX RUN OF RAPIDES PARISH 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	:	1598946295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOXX RUN OF RAPIDES PARISH LLC

Provider Business Mailing Address
First Line	:	2102 CABRINI AVE
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2102 CABRINI AVE
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3901
Country	:	US
Telephone Number	:	318-448-6357
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CALVIN DISMUKE
Credential	:	AUTHORIZED OFFICIAL
Telephone Number	:	318-448-6357

Provider Enumeration Date	:	11/21/2007
Last Update Date	:	11/21/2007

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