Provider Demographics
NPI:1194985937
Name:WILLIS TRANSPORTATION
Entity type:Organization
Organization Name:WILLIS TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DYLAN
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-573-6328
Mailing Address - Street 1:4814 CAMELLIA LN
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-5402
Mailing Address - Country:US
Mailing Address - Phone:318-573-6328
Mailing Address - Fax:318-377-0809
Practice Address - Street 1:4814 CAMELLIA LN
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5402
Practice Address - Country:US
Practice Address - Phone:318-573-6328
Practice Address - Fax:318-377-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)