Provider Demographics
NPI:1255940458
Name:ETTAA TRANSPORTATION OF LOUISIANA LLC
Entity type:Organization
Organization Name:ETTAA TRANSPORTATION OF LOUISIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EYOB
Authorized Official - Middle Name:H
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-785-5716
Mailing Address - Street 1:18808 HUNTINGTOWER CASTLE BLVD
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-7464
Mailing Address - Country:US
Mailing Address - Phone:512-785-5716
Mailing Address - Fax:
Practice Address - Street 1:201 RUE BEAUREGARD STE 202
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3251
Practice Address - Country:US
Practice Address - Phone:512-785-5716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)