Provider Demographics
NPI:1467970962
Name:WHITE MORRIS TRANSPORT, LLC
Entity type:Organization
Organization Name:WHITE MORRIS TRANSPORT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELECIA
Authorized Official - Middle Name:SHINTA
Authorized Official - Last Name:WHITE-MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-272-6633
Mailing Address - Street 1:8101 KINGSTON RD STE 101H
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71108-5745
Mailing Address - Country:US
Mailing Address - Phone:318-272-6633
Mailing Address - Fax:
Practice Address - Street 1:8101 KINGSTON RD STE 101H
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-5745
Practice Address - Country:US
Practice Address - Phone:318-272-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA42788542K343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3381273Medicaid