Provider Demographics
NPI:1104285642
Name:ETIENNE'S TRANSPORTATION
Entity type:Organization
Organization Name:ETIENNE'S TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ETIENNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:337-342-5973
Mailing Address - Street 1:1025 JOE BERTO LN
Mailing Address - Street 2:
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582-6735
Mailing Address - Country:US
Mailing Address - Phone:337-342-5973
Mailing Address - Fax:
Practice Address - Street 1:1025 JOE BERTO LN
Practice Address - Street 2:
Practice Address - City:SAINT MARTINVILLE
Practice Address - State:LA
Practice Address - Zip Code:70582-6735
Practice Address - Country:US
Practice Address - Phone:337-342-5973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ETIENNE'S TRANSPORTATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7081343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)