Provider Demographics
NPI:1023579695
Name:COURTESY CARRIERS L.L.C.
Entity Type:Organization
Organization Name:COURTESY CARRIERS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAQUESHA
Authorized Official - Middle Name:VL
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-518-2109
Mailing Address - Street 1:629 S BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2505
Mailing Address - Country:US
Mailing Address - Phone:316-587-7556
Mailing Address - Fax:
Practice Address - Street 1:629 S BEVERLY DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2505
Practice Address - Country:US
Practice Address - Phone:316-587-7556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201129180AMedicaid