Provider Demographics
NPI:1336638170
Name:LLOYD, LOUISE W (TRANSPORTATION PROVI)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:W
Last Name:LLOYD
Suffix:
Gender:F
Credentials:TRANSPORTATION PROVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-4063
Mailing Address - Country:US
Mailing Address - Phone:662-207-0903
Mailing Address - Fax:662-580-5121
Practice Address - Street 1:613 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4063
Practice Address - Country:US
Practice Address - Phone:662-207-0903
Practice Address - Fax:662-580-5121
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS801240644172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
8843OtherNON-EMERGENCY TRANSPORTATION