Provider Demographics
NPI:1962668780
Name:EASTB.R.MEDICALTRANSPORTATION
Entity type:Organization
Organization Name:EASTB.R.MEDICALTRANSPORTATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICALTRANSPORTATIPN
Authorized Official - Prefix:MS
Authorized Official - First Name:MISHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-978-2749
Mailing Address - Street 1:1755NORTH 16THST.
Mailing Address - Street 2:
Mailing Address - City:BATONROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802
Mailing Address - Country:US
Mailing Address - Phone:225-978-2749
Mailing Address - Fax:
Practice Address - Street 1:1755NORTH16ST.
Practice Address - Street 2:
Practice Address - City:BATONROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802
Practice Address - Country:US
Practice Address - Phone:225-978-2749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA003951623343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)