Healthcare Provider Details

I. General information

NPI: 1750007712
Provider Name (Legal Business Name): IF EXPRESS TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 S 17TH AVE
MAYWOOD IL
60153-1703
US

IV. Provider business mailing address

1009 S 17TH AVE
MAYWOOD IL
60153-1703
US

V. Phone/Fax

Practice location:
  • Phone: 708-356-6455
  • Fax:
Mailing address:
  • Phone: 708-356-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN C. DEVEAUX
Title or Position: CEO
Credential:
Phone: 708-356-6455