Healthcare Provider Details

I. General information

NPI: 1548402282
Provider Name (Legal Business Name): JASPERTRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 W STATE ST APT 608
WAUWATOSA WI
53213-2992
US

IV. Provider business mailing address

W350N5743 FIREFLY CT
OCONOMOWOC WI
53066-6711
US

V. Phone/Fax

Practice location:
  • Phone: 414-587-5780
  • Fax:
Mailing address:
  • Phone: 414-544-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. JASPER JOELL SYKES
Title or Position: OWNER
Credential:
Phone: 414-544-2400