Provider Demographics
NPI:1588319875
Name:PREMIUM CARE TRANSPORTATION LLP
Entity type:Organization
Organization Name:PREMIUM CARE TRANSPORTATION LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANDRE
Authorized Official - Middle Name:TRYMAN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-282-2111
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-0072
Mailing Address - Country:US
Mailing Address - Phone:318-282-2111
Mailing Address - Fax:
Practice Address - Street 1:5175 HALTERMAN RD
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5678
Practice Address - Country:US
Practice Address - Phone:318-282-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)