Provider Demographics
NPI:1043997307
Name:XTREME CARE TRANSPORT LLC
Entity type:Organization
Organization Name:XTREME CARE TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAYU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-374-5602
Mailing Address - Street 1:2703 E TOWER DR APT 205
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2638
Mailing Address - Country:US
Mailing Address - Phone:513-374-5602
Mailing Address - Fax:
Practice Address - Street 1:2703 E TOWER DR APT 205
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2638
Practice Address - Country:US
Practice Address - Phone:513-374-5602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)