Healthcare Provider Details

I. General information

NPI: 1659082329
Provider Name (Legal Business Name): XTREME ENTERPRISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 VANTAGE PT
MIRAMAR BEACH FL
32550-4864
US

IV. Provider business mailing address

748 DELAWARE ST
LEAVENWORTH KS
66048-2460
US

V. Phone/Fax

Practice location:
  • Phone: 850-502-3716
  • Fax:
Mailing address:
  • Phone: 913-651-9274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ANDREA HUTCHINSON
Title or Position: CEO
Credential:
Phone: 913-547-2929