=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689007932
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIGHT A WAY TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2013
-----------------------------------------------------
Last Update Date | 08/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4222 W CAPITOL DR STE 309
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53216-2500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-779-2799
-----------------------------------------------------
Fax | 866-229-7279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4222 W CAPITAL DR. SUITE #309
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-779-2799
-----------------------------------------------------
Fax | 866-229-7279
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. DARRELL F. WALLS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-779-2799
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | W420-1665-8408-04
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------