Organization
CUSTOM MEDICAL TRANSPORTATION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KONTINA VANESSA MITCHELL RN (OWNER/PRESIDENT)
(318) 288-3408
Entity
Organization
Contact information
Practice address
6701 BECKETT ST, SHREVEPORT, LA 71106-3323
(318) 288-3408
Mailing address
PO BOX 7, KEITHVILLE, LA 71047-0007
(318) 288-3408
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
40517229D
LA
Other
Enumeration date
05/26/2011
Last updated
05/26/2011
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