Provider Demographics
NPI:1235640251
Name:MEDGO TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:MEDGO TRANSPORTATION, LLC
Other - Org Name:MEDGO TRANSPORTATION, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-304-7034
Mailing Address - Street 1:1004 CHERRYHILL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-4912
Mailing Address - Country:US
Mailing Address - Phone:337-304-7034
Mailing Address - Fax:
Practice Address - Street 1:1004 CHERRYHILL ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-4912
Practice Address - Country:US
Practice Address - Phone:337-304-7034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)