=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538451349
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LETS GO TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2011
-----------------------------------------------------
Last Update Date | 05/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7327 W CONGRESS ST #6
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53218-5441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-855-6268
-----------------------------------------------------
Fax | 414-464-7827
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7327 W CONGRESS ST #6
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53218-5441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-855-6268
-----------------------------------------------------
Fax | 414-464-7827
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. IRENE N/A SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-855-6268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | S5304006175902
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------