Healthcare Provider Details

I. General information

NPI: 1760919393
Provider Name (Legal Business Name): FAMILY TRANSPORT LLC.,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S 50TH ST
WEST MILWAUKEE WI
53214-3533
US

IV. Provider business mailing address

1201 S 50TH ST
WEST MILWAUKEE WI
53214-3533
US

V. Phone/Fax

Practice location:
  • Phone: 414-383-8138
  • Fax:
Mailing address:
  • Phone: 414-383-8138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateWI

VIII. Authorized Official

Name: MR. EDUARDO RANGEL-SOLIS
Title or Position: PRESIDENT
Credential:
Phone: 414-383-8138