Healthcare Provider Details

I. General information

NPI: 1568188894
Provider Name (Legal Business Name): PANTHEON TRANSPORTATION GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 W CAPITOL DR STE 206
MILWAUKEE WI
53216-2155
US

IV. Provider business mailing address

12420 W HAMPTON AVE UNIT 164
BUTLER WI
53007-5008
US

V. Phone/Fax

Practice location:
  • Phone: 414-567-8551
  • Fax:
Mailing address:
  • Phone: 414-567-8551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY LITTLE
Title or Position: OWNER
Credential:
Phone: 414-567-8551