Provider Demographics
NPI:1093316523
Name:MOVEABLE TRANSPORTATION
Entity Type:Organization
Organization Name:MOVEABLE TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERMAINE
Authorized Official - Middle Name:DESHUNE
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-207-0546
Mailing Address - Street 1:1020 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3434
Mailing Address - Country:US
Mailing Address - Phone:318-207-0546
Mailing Address - Fax:
Practice Address - Street 1:1020 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3434
Practice Address - Country:US
Practice Address - Phone:318-207-0546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)