=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679032270
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAY MOBILITY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2019
-----------------------------------------------------
Last Update Date | 09/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 213 E 3RD ST
-----------------------------------------------------
City | WASHBURN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54891-9558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-718-6688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 213 E 3RD ST
-----------------------------------------------------
City | WASHBURN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54891-9558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-718-6688
-----------------------------------------------------
Fax | 715-718-6688
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ OPERATOR
-----------------------------------------------------
Name | MS. CARLA BECKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-718-6688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------