Provider Demographics
NPI:1376135061
Name:MCCLAIN'S TRAVELING GRACE MEDICAL TRANSPORTATION LLC
Entity Type:Organization
Organization Name:MCCLAIN'S TRAVELING GRACE MEDICAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:985-323-3384
Mailing Address - Street 1:30897 MASON DENVER LN
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:70443-3593
Mailing Address - Country:US
Mailing Address - Phone:985-323-3384
Mailing Address - Fax:
Practice Address - Street 1:30897 MASON DENVER LN
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:LA
Practice Address - Zip Code:70443-3593
Practice Address - Country:US
Practice Address - Phone:985-323-3384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)