Provider Demographics
NPI:1366810467
Name:EMPIRE MEDICAL TRANSPORTATION, LLC
Entity type:Organization
Organization Name:EMPIRE MEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AERIAL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-433-5985
Mailing Address - Street 1:PO BOX 16227
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70616-6227
Mailing Address - Country:US
Mailing Address - Phone:337-433-5985
Mailing Address - Fax:337-205-2715
Practice Address - Street 1:1320 BRIDLE WOOD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70615-5357
Practice Address - Country:US
Practice Address - Phone:337-433-5985
Practice Address - Fax:337-205-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2387413343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2387413OtherMOLINA MEDICAID PROVIDER NUMBER