Healthcare Provider Details

I. General information

NPI: 1124415146
Provider Name (Legal Business Name): WAKEFIELD TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 EDGEWATER PL STE 100
WAKEFIELD MA
01880-1281
US

IV. Provider business mailing address

301 EDGEWATER PL #100
WAKEFIELD MA
01880
US

V. Phone/Fax

Practice location:
  • Phone: 978-305-5095
  • Fax:
Mailing address:
  • Phone: 978-305-5095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberS18480951
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License NumberS18480951
License Number StateMA

VIII. Authorized Official

Name: JOSE RAMOS
Title or Position: OWNER
Credential:
Phone: 978-305-5095