=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144418542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY WIDE TRANSIT, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9245 N IRONWOOD LN
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53217-1212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-839-3880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9245 N IRONWOOD LN
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53217-1212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-839-3880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MAZEN HUSSEIN REZK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-839-3880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------