Provider Demographics
NPI:1629745229
Name:LOYAL MEDICAL TRANSPORTATION LLC.
Entity Type:Organization
Organization Name:LOYAL MEDICAL TRANSPORTATION LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMOKI
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:BERTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-302-4979
Mailing Address - Street 1:812 1/2 CELESTE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7570
Mailing Address - Country:US
Mailing Address - Phone:337-302-4979
Mailing Address - Fax:
Practice Address - Street 1:812 1/2 CELESTE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7570
Practice Address - Country:US
Practice Address - Phone:337-302-4979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)