Provider Demographics
NPI:1932430378
Name:CADDO MEDICAL TRANSPORTATION INCORPORATED
Entity type:Organization
Organization Name:CADDO MEDICAL TRANSPORTATION INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:BRASWELL
Authorized Official - Last Name:CARLISLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-850-1204
Mailing Address - Street 1:228 HARDERS CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8525
Mailing Address - Country:US
Mailing Address - Phone:214-850-1204
Mailing Address - Fax:
Practice Address - Street 1:228 HARDERS CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-8525
Practice Address - Country:US
Practice Address - Phone:214-850-1204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)