Healthcare Provider Details

I. General information

NPI: 1831484070
Provider Name (Legal Business Name): SAFEWAY TRANSPORTATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8648 N 53RD ST
BROWN DEER WI
53223-3010
US

IV. Provider business mailing address

8648 N 53RD ST
BROWN DEER WI
53223-3010
US

V. Phone/Fax

Practice location:
  • Phone: 414-264-9455
  • Fax: 414-264-4646
Mailing address:
  • Phone: 414-264-9455
  • Fax: 414-264-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number347E00000X
License Number StateWI

VIII. Authorized Official

Name: MISS GABRIELLE RABON
Title or Position: VICE PRESIDENT
Credential:
Phone: 414-405-4013