Provider Demographics
NPI:1053581181
Name:ON THE WAY TRANSPORTATION SERVICES
Entity type:Organization
Organization Name:ON THE WAY TRANSPORTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JACKQULINE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-470-8454
Mailing Address - Street 1:PO BOX 6541
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71136-6541
Mailing Address - Country:US
Mailing Address - Phone:318-470-8454
Mailing Address - Fax:
Practice Address - Street 1:3600 COLQUITT RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-4224
Practice Address - Country:US
Practice Address - Phone:318-470-8454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)