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General NPI Number Information
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NPI Number | 1710385547
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Entity Type | Organization
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Legal Business Name | XTRA MILE TRANSPORT NEMT LLC
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Dates
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Enumeration Date | 12/10/2014
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 16611 ELM ST
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2930
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Country | US
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Telephone | 708-299-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 16611 ELM ST
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2930
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Country | US
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Telephone | 708-299-7210
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JANET HODGES
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Credential |
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Telephone | 708-299-7210
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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 |
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License Number State | IL
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