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General NPI Number Information
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NPI Number | 1295185833
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Entity Type | Organization
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Legal Business Name | EXPRESS CHARTER, LLC
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Dates
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Enumeration Date | 06/14/2016
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 10507 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-2527
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Country | US
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Telephone | 773-309-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 10507 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-2527
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Country | US
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Telephone | 773-309-2100
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TATISHA CLEMONS
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Credential |
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Telephone | 773-309-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | C45580574850
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License Number State | IL
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