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General NPI Number Information
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NPI Number | 1346592144
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Entity Type | Organization
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Legal Business Name | WILLIS TRANSPORTATION SERVICE
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 6518 16TH ST
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City | BERWYN
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State | IL
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Zip | 60402-1310
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Country | US
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Telephone | 773-756-7894
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Fax |
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Provider Business Mailing Address
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Address Line | 6518 16TH ST
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City | BERWYN
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State | IL
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Zip | 60402-1310
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Country | US
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Telephone | 773-756-7894
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANTOINE WILLIS
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Credential |
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Telephone | 773-756-7894
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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 | W42000082307
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License Number State | IL
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