Active NPI
Annie Wells
- Vehicle Modifications Contractor
- Shreveport, LA
National Provider Identifier
1780032359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vehicle Modifications Contractor
- License
- 002803974
- Practice address
- 3113 Moore Station Rd
Shreveport, LA 71108-5043 - Phone
- (318) 423-4561
- Fax
- (318) 848-7713
- NPI assigned
- May 24, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vehicle Modifications Contractor | 171WV0202X | 002803974 | LA | Primary |
Addresses
Primary practice location
3113 Moore Station Rd
Shreveport, LA 71108-5043
Mailing address
3113 Moore Station Rd
Shreveport, LA 71108-5043
Phone (318) 423-4561
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 811916782 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002803974 | LA | MD | Vehicle Modifications Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| At Your Service Reliable Transport LLC. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Non-emergency Medical Transport (VAN)
- Shreveport, LA
- NPI 1770097941
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464048000000",
"number": "1780032359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3113 MOORE STATION RD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711085043",
"telephone_number": "318-423-4561",
"fax_number": "318-848-7713"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3113 MOORE STATION RD",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711085043",
"telephone_number": "318-423-4561",
"fax_number": "318-848-7713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WELLS",
"first_name": "ANNIE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-24",
"last_updated": "2016-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "171WV0202X",
"taxonomy_group": "",
"desc": "Contractor, Vehicle Modifications",
"state": "LA",
"license": "002803974",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "811916782",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.