Provider Demographics
NPI:1295164036
Name:XMAN EXPRESS LLC
Entity type:Organization
Organization Name:XMAN EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-391-9901
Mailing Address - Street 1:8617 N SERVITE DR
Mailing Address - Street 2:UNIT 209
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2577
Mailing Address - Country:US
Mailing Address - Phone:414-391-9901
Mailing Address - Fax:
Practice Address - Street 1:8617 N SERVITE DR
Practice Address - Street 2:UNIT 209
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-2577
Practice Address - Country:US
Practice Address - Phone:414-391-9901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100032417343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100032417Medicaid