Provider Demographics
NPI:1558013250
Name:PETE, ALFRED H
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:H
Last Name:PETE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 US 90 LOT 214
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARL;ES
Mailing Address - State:LA
Mailing Address - Zip Code:70601
Mailing Address - Country:US
Mailing Address - Phone:337-526-0649
Mailing Address - Fax:
Practice Address - Street 1:2304 KIRKMAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7450
Practice Address - Country:US
Practice Address - Phone:337-526-0649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)