Provider Demographics
NPI:1215489380
Name:LOUISIANA MEDIC TRANSPORT LLC
Entity type:Organization
Organization Name:LOUISIANA MEDIC TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAISTA
Authorized Official - Middle Name:WAQAR
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-820-0094
Mailing Address - Street 1:223 LAKE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-9035
Mailing Address - Country:US
Mailing Address - Phone:318-820-0094
Mailing Address - Fax:
Practice Address - Street 1:223 LAKE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-9035
Practice Address - Country:US
Practice Address - Phone:318-820-0094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17496 PT343900000X
LAA826612343900000X
LAA826613343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)