Provider Demographics
NPI:1912615907
Name:LILLY'S EXPRESS TRANSPORT, LLC
Entity Type:Organization
Organization Name:LILLY'S EXPRESS TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEMLEM
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-434-7956
Mailing Address - Street 1:6000 REIMS RD APT 2506
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3052
Mailing Address - Country:US
Mailing Address - Phone:904-434-7956
Mailing Address - Fax:
Practice Address - Street 1:6000 REIMS RD APT 2506
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3052
Practice Address - Country:US
Practice Address - Phone:904-434-7956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)