Healthcare Provider Details

I. General information

NPI: 1730863770
Provider Name (Legal Business Name): F.A.S.T FATHER AND SON'S TRANSIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3951 N 24TH PL
MILWAUKEE WI
53206-1422
US

IV. Provider business mailing address

3951 N 24TH PL
MILWAUKEE WI
53206-1422
US

V. Phone/Fax

Practice location:
  • Phone: 414-639-0100
  • Fax:
Mailing address:
  • Phone: 414-639-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name: PHILLIP LAWRENCE
Title or Position: OWNER C.E.O.
Credential:
Phone: 414-639-0100