Provider Demographics
NPI:1013722339
Name:XWA 2024 LLC
Entity type:Organization
Organization Name:XWA 2024 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-577-5698
Mailing Address - Street 1:2403 AIR CARGO DR
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-8944
Mailing Address - Country:US
Mailing Address - Phone:608-577-5698
Mailing Address - Fax:
Practice Address - Street 1:14151 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-8018
Practice Address - Country:US
Practice Address - Phone:608-577-5698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
No341600000XTransportation ServicesAmbulance