Provider Demographics
NPI:1770041287
Name:REDSTICK STATE
Entity Type:Organization
Organization Name:REDSTICK STATE
Other - Org Name:REDSTICK STATE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-678-3770
Mailing Address - Street 1:301 MAIN ST STE 2200
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70801-0014
Mailing Address - Country:US
Mailing Address - Phone:225-678-3770
Mailing Address - Fax:
Practice Address - Street 1:301 MAIN ST STE 2200
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70801-0014
Practice Address - Country:US
Practice Address - Phone:225-678-3770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)