Provider Demographics
NPI:1316616386
Name:EXTENDED TRAVELS
Entity type:Organization
Organization Name:EXTENDED TRAVELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PERCENIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-531-9780
Mailing Address - Street 1:6534 N BEALE ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-5208
Mailing Address - Country:US
Mailing Address - Phone:414-531-9780
Mailing Address - Fax:
Practice Address - Street 1:6534 N BEALE ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-5208
Practice Address - Country:US
Practice Address - Phone:414-531-9780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)