Provider Demographics
NPI:1912394065
Name:WILEY EXPRESS TRANSPORT LLC
Entity Type:Organization
Organization Name:WILEY EXPRESS TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:972-342-2082
Mailing Address - Street 1:4041 W WHEATLAND RD
Mailing Address - Street 2:SUITE 156-356
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-4063
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2523 CLUB TERRACE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2707
Practice Address - Country:US
Practice Address - Phone:972-342-2082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)