Provider Demographics
NPI:1093345084
Name:KEITHMEDTRANSPORTATIONLLC
Entity Type:Organization
Organization Name:KEITHMEDTRANSPORTATIONLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRANSPORTATION PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:JHON
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:504-339-1372
Mailing Address - Street 1:522 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-9428
Mailing Address - Country:US
Mailing Address - Phone:504-339-1372
Mailing Address - Fax:985-370-2056
Practice Address - Street 1:522 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:PONCHATOULA
Practice Address - State:LA
Practice Address - Zip Code:70454-9428
Practice Address - Country:US
Practice Address - Phone:504-339-1372
Practice Address - Fax:985-370-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)