Provider Demographics
NPI:1679243463
Name:MTZ RISING SUNS TRANSPORTATION LLC
Entity Type:Organization
Organization Name:MTZ RISING SUNS TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVERICK
Authorized Official - Middle Name:RAYDRAKEYON
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-717-4399
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:SIMMESPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71369-0069
Mailing Address - Country:US
Mailing Address - Phone:318-717-4399
Mailing Address - Fax:
Practice Address - Street 1:403 COLLEGE DRIVE
Practice Address - Street 2:
Practice Address - City:SIMMESPORT
Practice Address - State:LA
Practice Address - Zip Code:71369
Practice Address - Country:US
Practice Address - Phone:318-359-3497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3187174399Medicaid