MEDICARE: WILLIS TRANSPORTATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)		LA

General Provider Information

NPI Number	:	1194985937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIS TRANSPORTATION

Provider Business Mailing Address
First Line	:	4814 CAMELLIA LN
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5402
Country	:	US
Telephone Number	:	318-573-6328
Fax Number	:	318-377-0809

Provider Business Practice Location Address
First Line	:	4814 CAMELLIA LN
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5402
Country	:	US
Telephone Number	:	318-573-6328
Fax Number	:	318-377-0809

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAMES DYLAN WILLIS
Credential	:
Telephone Number	:	318-573-6328

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	06/16/2008

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Directions to “WILLIS TRANSPORTATION ” Practice Location

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