Provider Demographics
NPI:1861866907
Name:NORTHWEST REGIONAL TRANSPORTATION
Entity Type:Organization
Organization Name:NORTHWEST REGIONAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:318-828-1500
Mailing Address - Street 1:1535 RIVER PARKWAY BLVD
Mailing Address - Street 2:STE 1108
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-1808
Mailing Address - Country:US
Mailing Address - Phone:318-828-1500
Mailing Address - Fax:318-670-3736
Practice Address - Street 1:1535 RIVER PARKWAY BLVD
Practice Address - Street 2:STE 1108
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-1808
Practice Address - Country:US
Practice Address - Phone:318-828-1500
Practice Address - Fax:318-670-3736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-29
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)