Provider Demographics
NPI:1356900724
Name:MIRAGE TRANSPORTATION SERVICES LLC
Entity type:Organization
Organization Name:MIRAGE TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZERINGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-289-1698
Mailing Address - Street 1:448 CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:EDGARD
Mailing Address - State:LA
Mailing Address - Zip Code:70049-2526
Mailing Address - Country:US
Mailing Address - Phone:504-289-1698
Mailing Address - Fax:
Practice Address - Street 1:448 CASTLE DR
Practice Address - Street 2:
Practice Address - City:EDGARD
Practice Address - State:LA
Practice Address - Zip Code:70049-2526
Practice Address - Country:US
Practice Address - Phone:504-289-1698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)