Provider Demographics
NPI:1083883698
Name:CENTRAL MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:CENTRAL MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:318-248-3253
Mailing Address - Street 1:183 SARTOR RD
Mailing Address - Street 2:
Mailing Address - City:MANGHAM
Mailing Address - State:LA
Mailing Address - Zip Code:71259-5208
Mailing Address - Country:US
Mailing Address - Phone:318-248-3253
Mailing Address - Fax:
Practice Address - Street 1:183 SARTOR RD
Practice Address - Street 2:
Practice Address - City:MANGHAM
Practice Address - State:LA
Practice Address - Zip Code:71259-5208
Practice Address - Country:US
Practice Address - Phone:318-248-3253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1964361343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4501922OtherSUMBITTER NUMBER
LA1964361OtherPROVIDER NUMBER
LA42OtherPARISH CODE