Provider Demographics
NPI:1508697723
Name:IMPACT TRANSIT SERVICE
Entity type:Organization
Organization Name:IMPACT TRANSIT SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RASBY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MASON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:318-349-9394
Mailing Address - Street 1:1007 GOULD DRIVE
Mailing Address - Street 2:BUILDING 1 SUITE 1
Mailing Address - City:BOSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111
Mailing Address - Country:US
Mailing Address - Phone:318-349-9394
Mailing Address - Fax:318-626-7179
Practice Address - Street 1:4727 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-6908
Practice Address - Country:US
Practice Address - Phone:318-349-9394
Practice Address - Fax:318-470-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA