Provider Demographics
NPI:1518705599
Name:XXTRAMILE TRANSPORTATION LLC
Entity type:Organization
Organization Name:XXTRAMILE TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JHAMAL
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:SHELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-220-2764
Mailing Address - Street 1:809 BELL VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461
Mailing Address - Country:US
Mailing Address - Phone:504-939-4593
Mailing Address - Fax:
Practice Address - Street 1:809 BELL VALLEY CT
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461
Practice Address - Country:US
Practice Address - Phone:504-939-4593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)