MEDICARE: FIRST RESPONSE TRANSPORT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)		WI

General Provider Information

NPI Number	:	1528552163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST RESPONSE TRANSPORT LLC

Provider Business Mailing Address
First Line	:	1701 S 5TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3501
Country	:	US
Telephone Number	:	414-810-8080
Fax Number	:	414-810-4992

Provider Business Practice Location Address
First Line	:	1701 S 5TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3501
Country	:	US
Telephone Number	:	414-810-8080
Fax Number	:	414-810-4992

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN ASHRAF
Credential	:	TRANSPORTATION
Telephone Number	:	414-698-2996

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	06/18/2018

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