MEDICARE: ANDRE O CLAIBORNE

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)	005624987	LA

General Provider Information

NPI Number	:	1790242535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRE O CLAIBORNE

Provider Business Mailing Address
First Line	:	4348 E MARIBEL CT
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70812-4027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4348 E MARIBEL CT
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70812-4027
Country	:	US
Telephone Number	:	225-266-8396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	02/28/2019

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Directions to “ ANDRE O CLAIBORNE ” Practice Location

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