Provider Demographics
NPI:1669934501
Name:STATEWIDE TRANS INC
Entity type:Organization
Organization Name:STATEWIDE TRANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:KHALED
Authorized Official - Last Name:ABDELSALAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-709-1595
Mailing Address - Street 1:3028 N MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-4142
Mailing Address - Country:US
Mailing Address - Phone:318-709-1595
Mailing Address - Fax:318-704-6333
Practice Address - Street 1:3028 N MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-4142
Practice Address - Country:US
Practice Address - Phone:318-709-1595
Practice Address - Fax:318-704-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00000000Other00000000