Healthcare Provider Details

I. General information

NPI: 1639354939
Provider Name (Legal Business Name): MACS AND BALL TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8209 W KIEHNAU AVE
MILWAUKEE WI
53223-5548
US

IV. Provider business mailing address

8209 W KIEHNAU AVE
MILWAUKEE WI
53223-5548
US

V. Phone/Fax

Practice location:
  • Phone: 414-353-5593
  • Fax:
Mailing address:
  • Phone: 414-353-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number41482500
License Number StateWI

VIII. Authorized Official

Name: DAVID MCGLOTHIAN
Title or Position: PRESIDENT
Credential:
Phone: 414-353-5593