Healthcare Provider Details

I. General information

NPI: 1154560159
Provider Name (Legal Business Name): PDQ MEDICAL TRANSIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 S GIBSON ST
MEDFORD WI
54451-1681
US

IV. Provider business mailing address

880 S GIBSON ST
MEDFORD WI
54451-1681
US

V. Phone/Fax

Practice location:
  • Phone: 715-748-2262
  • Fax: 715-748-2262
Mailing address:
  • Phone: 715-748-2262
  • Fax: 715-748-2262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. PAUL WILLIAM PERNSTEINER
Title or Position: CEO
Credential:
Phone: 715-748-2262