Provider Demographics
NPI:1710645429
Name:IRVINE, TYRONE JR
Entity Type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:
Last Name:IRVINE
Suffix:JR
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 1:4297 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:ETHEL
Mailing Address - State:LA
Mailing Address - Zip Code:70730-3140
Mailing Address - Country:US
Mailing Address - Phone:225-301-8643
Mailing Address - Fax:
Practice Address - Street 1:4297 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:ETHEL
Practice Address - State:LA
Practice Address - Zip Code:70730-3140
Practice Address - Country:US
Practice Address - Phone:225-301-8643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)