Provider Demographics
NPI:1710102413
Name:JR MEDICAL TRANSPORTATION INC.
Entity Type:Organization
Organization Name:JR MEDICAL TRANSPORTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS JR.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-413-8982
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:WHITE CASTLE
Mailing Address - State:LA
Mailing Address - Zip Code:70788-0142
Mailing Address - Country:US
Mailing Address - Phone:225-413-8982
Mailing Address - Fax:225-545-0131
Practice Address - Street 1:57335 CPL HERMAN BROWN JR ST
Practice Address - Street 2:
Practice Address - City:WHITE CASTLE
Practice Address - State:LA
Practice Address - Zip Code:70788-3122
Practice Address - Country:US
Practice Address - Phone:225-413-8982
Practice Address - Fax:225-545-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1612243343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1612243Medicaid