Provider Demographics
NPI:1962141804
Name:ALFRED, OTTIS JAMES
Entity type:Individual
Prefix:
First Name:OTTIS
Middle Name:JAMES
Last Name:ALFRED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HEYMANN BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2404
Mailing Address - Country:US
Mailing Address - Phone:337-303-3227
Mailing Address - Fax:
Practice Address - Street 1:201 HEYMANN BLVD STE 10
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2404
Practice Address - Country:US
Practice Address - Phone:337-303-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245687923OtherNON-MEDICAL TRANSPORTATION
LA1245687923Medicaid