Healthcare Provider Details

I. General information

NPI: 1265613665
Provider Name (Legal Business Name): E & D TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 W ELM ST
MILWAUKEE WI
53209-3106
US

IV. Provider business mailing address

PO BOX 100332
MILWAUKEE WI
53210-0332
US

V. Phone/Fax

Practice location:
  • Phone: 414-228-9313
  • Fax:
Mailing address:
  • Phone: 414-228-9313
  • Fax: 414-228-9315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License NumberJ2501924663605
License Number StateWI

VIII. Authorized Official

Name: MS. DOROTHY JACKSON
Title or Position: PRESIDENT
Credential:
Phone: 414-228-9313