Provider Demographics
NPI:1225369994
Name:SLM NONEMERGENCY MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:SLM NONEMERGENCY MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AKEMEY
Authorized Official - Middle Name:CHARLENE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:985-224-9604
Mailing Address - Street 1:P.O. BOX 1560
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-1560
Mailing Address - Country:US
Mailing Address - Phone:985-331-2309
Mailing Address - Fax:985-331-2310
Practice Address - Street 1:737 PAUL MAILLARD ROAD
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070
Practice Address - Country:US
Practice Address - Phone:985-331-2309
Practice Address - Fax:985-331-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)