Healthcare Provider Details

I. General information

NPI: 1972467603
Provider Name (Legal Business Name): MED TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10521 W GREENWOOD TER
MILWAUKEE WI
53224-3721
US

IV. Provider business mailing address

10521 W GREENWOOD TER
MILWAUKEE WI
53224-3721
US

V. Phone/Fax

Practice location:
  • Phone: 414-373-0477
  • Fax:
Mailing address:
  • Phone: 414-373-0477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MARISSA VERONICA MEDINA
Title or Position: OWNER
Credential:
Phone: 414-373-0477