Healthcare Provider Details

I. General information

NPI: 1811694565
Provider Name (Legal Business Name): EDWARD JAMES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 S 39TH ST
MILWAUKEE WI
53215-1005
US

IV. Provider business mailing address

PO BOX 340226
MILWAUKEE WI
53234-0226
US

V. Phone/Fax

Practice location:
  • Phone: 414-807-6806
  • Fax:
Mailing address:
  • Phone: 414-807-6806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2278P4000X
TaxonomyPatient Transport Certified Respiratory Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2279P4000X
TaxonomyPatient Transport Registered Respiratory Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: