Provider Demographics
NPI:1972062651
Name:A W MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:A W MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-693-9445
Mailing Address - Street 1:136 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-4302
Mailing Address - Country:US
Mailing Address - Phone:337-693-9445
Mailing Address - Fax:
Practice Address - Street 1:136 GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-4302
Practice Address - Country:US
Practice Address - Phone:337-693-9445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA43333677KOtherSECRETARY OF STATE