Provider Demographics
NPI:1922321231
Name:MEDICAB, L.L.C.
Entity Type:Organization
Organization Name:MEDICAB, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLFLESH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-767-2420
Mailing Address - Street 1:PO BOX 14525
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-4525
Mailing Address - Country:US
Mailing Address - Phone:318-767-2420
Mailing Address - Fax:
Practice Address - Street 1:303 SYCAMORE DRIVE
Practice Address - Street 2:
Practice Address - City:BOYCE
Practice Address - State:LA
Practice Address - Zip Code:71409
Practice Address - Country:US
Practice Address - Phone:318-767-2420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00112987343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)