Provider Demographics
NPI:1184481426
Name:NORTH LOUISIANA MEDICAL TRANSPORT
Entity type:Organization
Organization Name:NORTH LOUISIANA MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:
Authorized Official - First Name:CALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-379-4244
Mailing Address - Street 1:350 DESIARD PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-4922
Mailing Address - Country:US
Mailing Address - Phone:318-379-4244
Mailing Address - Fax:
Practice Address - Street 1:350 DESIARD PLAZA DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-4922
Practice Address - Country:US
Practice Address - Phone:318-379-4244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)