Healthcare Provider Details

I. General information

NPI: 1265771927
Provider Name (Legal Business Name): MEDVAN TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N9211 COUNTY RD N
NESHKORO WI
54960-9031
US

IV. Provider business mailing address

N9211 COUNTY RD N
NESHKORO WI
54960-9031
US

V. Phone/Fax

Practice location:
  • Phone: 920-293-4386
  • Fax: 920-293-4386
Mailing address:
  • Phone: 920-293-4386
  • Fax: 920-293-4386

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: MR. SCOTT MATTHEW LANGER
Title or Position: OWNER
Credential:
Phone: 920-293-4386