Provider Demographics
NPI:1760847271
Name:BENTON MEDICAL TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:BENTON MEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-678-4365
Mailing Address - Street 1:6521 CHIPPENDALE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-3530
Mailing Address - Country:US
Mailing Address - Phone:225-678-4365
Mailing Address - Fax:225-421-1673
Practice Address - Street 1:6521 CHIPPENDALE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-3530
Practice Address - Country:US
Practice Address - Phone:225-678-4365
Practice Address - Fax:225-421-1673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA006733391343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)