Provider Demographics
NPI:1669003877
Name:WILHITE, RONALD SR
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:WILHITE
Suffix:SR
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 1:401 MORRIS DR
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-6009
Mailing Address - Country:US
Mailing Address - Phone:318-614-9129
Mailing Address - Fax:
Practice Address - Street 1:401 MORRIS DR
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-6009
Practice Address - Country:US
Practice Address - Phone:318-614-9129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18000280343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)