Provider Demographics
NPI:1205635075
Name:SUPERTRANSPORT LLC
Entity type:Organization
Organization Name:SUPERTRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAROON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:318-557-0125
Mailing Address - Street 1:303 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-4247
Mailing Address - Country:US
Mailing Address - Phone:318-557-0125
Mailing Address - Fax:
Practice Address - Street 1:303 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-4247
Practice Address - Country:US
Practice Address - Phone:318-557-0125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)