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General NPI Number Information
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NPI Number | 1568622074
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Entity Type | Organization
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Legal Business Name | NORTHEAST WISCONSIN TRANSPORTATION SERVICES INC
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 9431 COUNTY ROAD D
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City | FORESTVILLE
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State | WI
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Zip | 54213
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Country | US
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Telephone | 920-825-7411
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Fax |
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Provider Business Mailing Address
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Address Line | 214 CLOVER AVE
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City | EAST PEORIA
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State | IL
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Zip | 61611-4609
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Country | US
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Telephone | 920-825-7411
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEANNE LACROSSE
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Credential |
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Telephone | 920-825-7411
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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 | 41440500
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License Number State | WI
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