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NPI Code Detail

MEDICARE: XTRA MILE HEALTH CARE TRANSPORT LLC

MEDICARE: XTRA MILE HEALTH CARE TRANSPORT LLC
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
1343900000XNon-emergency Medical Transport (VAN)

General Provider Information

NPI Number : 1558219212
Entity Type Code : Organization
Provider Name (Legal Business Name) : XTRA MILE HEALTH CARE TRANSPORT LLC
Provider Business Mailing Address
First Line : 514 BLUE GARDEN WAY
Second Line :
City : COLUMBIA
State : SC
Zip : 29223-8053
Country : US
Telephone Number : 803-949-5335
Fax Number :
Provider Business Practice Location Address
First Line : 514 BLUE GARDEN WAY
Second Line :
City : COLUMBIA
State : SC
Zip : 29223-8053
Country : US
Telephone Number : 803-949-5335
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DEION LONDON
Credential : LONDON
Telephone Number : 803-949-5335
Provider Enumeration Date : 03/18/2026
Last Update Date : 03/18/2026

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Directions to “XTRA MILE HEALTH CARE TRANSPORT LLC ” Practice Location

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