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General NPI Number Information
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NPI Number | 1437472966
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Entity Type | Organization
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Legal Business Name | BROTOLOC SOUTH, INC.
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 03/12/2010
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Provider Practice Location Address
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Address Line | 5812 W BURNHAM ST
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City | WEST ALLIS
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State | WI
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Zip | 53219-1524
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Country | US
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Telephone | 414-543-3200
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Fax | 414-543-3269
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Provider Business Mailing Address
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Address Line | 5812 W BURNHAM ST
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City | WEST ALLIS
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State | WI
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Zip | 53219-1524
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Country | US
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Telephone | 414-543-3200
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Fax | 414-543-3269
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Authorized Official
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Title or Position | REGIONAL DIRECTOR
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Name | DOUGLAS SVEDA
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Credential |
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Telephone | 414-543-3200
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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 | 41487500
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License Number State | WI
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