Healthcare Provider Details

I. General information

NPI: 1003756883
Provider Name (Legal Business Name): WILDCAT LEGACY TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50288 CHIMNEY ROCK RD
ELEVA WI
54738-9305
US

IV. Provider business mailing address

PO BOX 7
ELEVA WI
54738-0007
US

V. Phone/Fax

Practice location:
  • Phone: 715-533-0194
  • Fax:
Mailing address:
  • Phone: 715-533-0194
  • 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. ANDREW RICHARD EVENSON
Title or Position: OWNER
Credential:
Phone: 715-533-0194