Medi Trans, LLC

Primary specialty

Transportation BrokerTaxonomy code 347E00000X

Legal business name

MEDI TRANS, LLC

Practice address

102 Asma Blvd Ste 200
Lafayette, LA 70508-3843

Phone

(337) 366-6618

Fax

(337) 534-4485

NPI assigned

May 17, 2007

Last updated

Jan 23, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Paul A. Broussard

Title

Ceo

Phone

(337) 534-4484

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674432000000",
    "number": "1689881575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 ASMA BLVD STE 200",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083843",
            "telephone_number": "337-366-6618",
            "fax_number": "337-534-4485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 ASMA BLVD STE 200",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083843",
            "telephone_number": "337-366-6618",
            "fax_number": "337-534-4485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDI TRANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "337-534-4484"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "347E00000X",
            "taxonomy_group": "",
            "desc": "Transportation Broker",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011053",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.