Healthcare Provider Details

I. General information

NPI: 1760796403
Provider Name (Legal Business Name): COMMUNITY TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5429 N 106TH STREET
MILWAUKEE WI
53225-3207
US

IV. Provider business mailing address

5429 NORTH 106TH STREET
MILWUKEE WI
53225-3207
US

V. Phone/Fax

Practice location:
  • Phone: 262-770-7689
  • Fax:
Mailing address:
  • Phone: 262-770-7689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. TRACY L ROBERTS
Title or Position: OWREN
Credential:
Phone: 262-770-7689