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General NPI Number Information
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NPI Number | 1306161252
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Entity Type | Organization
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Legal Business Name | EXPRESS TRANSPORTATION OF WI, LLC
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 04/05/2010
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Provider Practice Location Address
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Address Line | 9675 S 54TH ST
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City | FRANKLIN
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State | WI
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Zip | 53132-9825
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Country | US
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Telephone | 414-235-3668
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Fax | 414-235-4933
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Provider Business Mailing Address
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Address Line | 9675 S 54TH ST
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City | FRANKLIN
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State | WI
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Zip | 53132-9825
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Country | US
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Telephone | 414-235-3668
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Fax | 414-235-4933
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. DAVID DEVEREAUX
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Credential |
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Telephone | 414-235-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 100005686
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License Number State | WI
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