Healthcare Provider Details

I. General information

NPI: 1992471304
Provider Name (Legal Business Name): LIR TRANSPORTATION DBA FOX VALLEY CAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 W FRANCES ST
APPLETON WI
54914-2365
US

IV. Provider business mailing address

719 W FRANCES ST
APPLETON WI
54914-2365
US

V. Phone/Fax

Practice location:
  • Phone: 920-734-4545
  • Fax: 920-734-0557
Mailing address:
  • Phone: 920-734-4545
  • Fax: 920-734-0557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIEL WILLIAM GLASHEEN
Title or Position: SUPPORT MANAGER
Credential:
Phone: 920-734-4545