Provider Demographics
NPI:1174719645
Name:M & M MEDICAL TRANSPORTATION, INC
Entity type:Organization
Organization Name:M & M MEDICAL TRANSPORTATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANNISSA
Authorized Official - Middle Name:EVEQUE
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-680-6881
Mailing Address - Street 1:803 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-8039
Mailing Address - Country:US
Mailing Address - Phone:318-323-5212
Mailing Address - Fax:
Practice Address - Street 1:803 S 27TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-8039
Practice Address - Country:US
Practice Address - Phone:318-323-5212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1930806343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1930806Medicaid