Provider Demographics
NPI:1235971532
Name:FULLER PREMIER TRANSPORTATION LLC
Entity type:Organization
Organization Name:FULLER PREMIER TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:FULLER
Authorized Official - Last Name:CHARLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-518-1971
Mailing Address - Street 1:3740 MERWIN ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71109-4720
Mailing Address - Country:US
Mailing Address - Phone:318-518-1971
Mailing Address - Fax:
Practice Address - Street 1:3740 MERWIN ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-4720
Practice Address - Country:US
Practice Address - Phone:318-518-1971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)