Provider Demographics
NPI:1750154522
Name:ARD, MARIO M SR
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:M
Last Name:ARD
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 SOUTHERN GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-6538
Mailing Address - Country:US
Mailing Address - Phone:318-235-5783
Mailing Address - Fax:
Practice Address - Street 1:404 SOUTHERN GROVE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-6538
Practice Address - Country:US
Practice Address - Phone:318-235-5783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)