Healthcare Provider Details

I. General information

NPI: 1538574629
Provider Name (Legal Business Name): MEDICAL TRANSPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 BRIEN ST APT 2
NEENAH WI
54956-2599
US

IV. Provider business mailing address

216 BRIEN ST APT 2
NEENAH WI
54956-2599
US

V. Phone/Fax

Practice location:
  • Phone: 920-205-4113
  • Fax:
Mailing address:
  • Phone: 920-205-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateWI

VIII. Authorized Official

Name: MR. XUE YANG
Title or Position: OWNER
Credential:
Phone: 920-205-4113