Provider Demographics
NPI:1689111296
Name:MADI PICKUP & DROPOFF L.L.C
Entity Type:Organization
Organization Name:MADI PICKUP & DROPOFF L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DERON
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-357-7731
Mailing Address - Street 1:2616 FLAMINGO DR
Mailing Address - Street 2:
Mailing Address - City:SAINT BERNARD
Mailing Address - State:LA
Mailing Address - Zip Code:70085-5516
Mailing Address - Country:US
Mailing Address - Phone:504-357-7731
Mailing Address - Fax:
Practice Address - Street 1:2616 FLAMINGO DR
Practice Address - Street 2:
Practice Address - City:SAINT BERNARD
Practice Address - State:LA
Practice Address - Zip Code:70085-5516
Practice Address - Country:US
Practice Address - Phone:504-357-7731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-22
Last Update Date:2017-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)