Provider Demographics
NPI:1013519594
Name:EXTRAORDINARY TRANSPORT SERVICES LLC
Entity type:Organization
Organization Name:EXTRAORDINARY TRANSPORT SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-606-6863
Mailing Address - Street 1:3200 E 94TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-2846
Mailing Address - Country:US
Mailing Address - Phone:816-606-6863
Mailing Address - Fax:
Practice Address - Street 1:3200 E 94TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-2846
Practice Address - Country:US
Practice Address - Phone:816-606-6863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)