Provider Demographics
NPI:1154186195
Name:JOSEPH, TREVEION A SR
Entity type:Individual
Prefix:MR
First Name:TREVEION
Middle Name:A
Last Name:JOSEPH
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 RUE VIANSA
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-3944
Mailing Address - Country:US
Mailing Address - Phone:337-371-8049
Mailing Address - Fax:
Practice Address - Street 1:106 RUE VIANSA
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-3944
Practice Address - Country:US
Practice Address - Phone:337-371-8049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA93-2504866Medicaid