Provider Demographics
NPI:1255003778
Name:MPM'S MEDICAL TRANSPORT, LLC
Entity Type:Organization
Organization Name:MPM'S MEDICAL TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-572-3102
Mailing Address - Street 1:8169 MYRTLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:71033-3025
Mailing Address - Country:US
Mailing Address - Phone:318-572-3102
Mailing Address - Fax:
Practice Address - Street 1:8169 MYRTLEWOOD RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:LA
Practice Address - Zip Code:71033-3025
Practice Address - Country:US
Practice Address - Phone:318-572-3102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-03
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)