Healthcare Provider Details

I. General information

NPI: 1831756162
Provider Name (Legal Business Name): UPLIFTING TRANSPORT SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 W FLORIDA AVE
APPLETON WI
54914-1156
US

IV. Provider business mailing address

PO BOX 171
APPLETON WI
54912-0171
US

V. Phone/Fax

Practice location:
  • Phone: 920-442-0277
  • Fax:
Mailing address:
  • Phone: 920-574-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSH RODMAN
Title or Position: OWNER
Credential:
Phone: 920-442-0277