Provider Demographics
NPI:1316668759
Name:GERMANY, ANDRE SR
Entity type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:
Last Name:GERMANY
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 1:1068 WOODSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-2837
Mailing Address - Country:US
Mailing Address - Phone:318-834-4606
Mailing Address - Fax:
Practice Address - Street 1:1068 WOODSHIRE CIR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-2837
Practice Address - Country:US
Practice Address - Phone:318-834-4606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA07656276Medicaid